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van Wiechen et al. Mini-invasive Surg 2022;6:1 https://dx.doi.org/10.20517/2574-1225.2021.96 Page 3 of 11

Table 1. Criteria for EXPRES eligibility
TAVI Strategy
Transfemoral approach
Suitable for Edwards Sapien 3 or Acurate NEO
Any TAVI device when permanent pacemaker is in place
Cardiac criteria should exclude
Poor systolic LV function defined by LVEF < 35%
More than moderate tricuspid or mitral regurgitation
Severe pulmonary hypertension (sPAP > 60 mmHg)
Untreated high degree AV-block or RBBB
Pulmonary criteria should exclude
COPD Gold class > 2
Kidney criteria should exclude
eGFR < 35 mL/min
Frailty
Independent in Katz activities of daily living
Presence of adequate social or family support

TAVI: Transcatheter aortic valve implantation; LVEF: left ventricular ejection fraction; sPAP: systolic pulmonary artery pressure; AV:
atrioventricular; RBBB: right bundle branch block; COPD: chronic obstructive pulmonary disease; eGFR: estimated glomerular filtration rate.

support, and consented eligible candidates. For EXPRES patients without a pacemaker at baseline,
preferably an Edwards Sapien S3 (Edwards Lifesciences Corp., Irvine, California) or Acurate NEO (Boston
Scientific, Marlborough, Massachusetts) valve was implanted because these transcatheter heart valve (THV)
platforms seem associated with the lowest risk for high-degree conduction disorders [11,12] .

Patients who were scheduled for early transfer to a referring hospital after the procedure were included in
the R-EXPRES cohort. All patients were eligible for R-EXPRES except those who were enrolled in the
EXPRES cohort. Patients were only transferred to the referring hospital if: (1) they were hemodynamically
stable; (2) device success was confirmed; (3) there were no unresolved major procedure related
complications; (4) there was no need for a temporary pacemaker; and (5) the referral hospital had logistics
in place to accommodate patients post TAVI.

Study procedures
All patients were discussed in a multidisciplinary heart team including a cardiac surgeon, an interventional
cardiologist, an imaging specialist, and a geriatrician. For R-EXPRES patients, all imaging, including
transthoracic echocardiogram (TTE), multislice computed tomography, and coronary angiogram, was
provided by the referring hospital. THV size and access strategy was determined by the valve center. All
TAVI procedures took place at the heart valve center.

Discharge policy
The standard post-procedural clinical pathway consisted of daily electrocardiograms, laboratory assessment,
and TTE pre discharge.

Patients earmarked for the EXPRES pathway were scheduled to be discharged home within 24 h unless
longer observation was required (e.g., because of lingering conduction disorders or unresolved procedure
related complications). They were followed up through phone calls one and seven days post discharge.
Discharge policy was always left at the treating physician’s discretion.