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Page 4 of 11 van Wiechen et al. Mini-invasive Surg 2022;6:1 https://dx.doi.org/10.20517/2574-1225.2021.96

Patients in the R-EXPRES program were discharged to the referring hospital within 24 h in the absence of a
temporary pace wire or unresolved major procedure-related complications.

Clinical outcomes and event screening
Baseline demographics, procedure characteristics, and in-hospital and 30-day clinical outcomes were
collected in a dedicated prospective database. Discharge letters from referring hospitals were collected to
determine length of stay (LOS) and screen for in-hospital events (for R-EXPRES patients). All patients were
seen at the outpatient clinic 4-6 weeks after the procedure; clinical events that occurred between hospital
discharge and 30-day follow-up were collected. All events were classified according to Valve Academic
Research Consortium (VARC-2) definitions .
[13]

Statistical analysis
Baseline characteristics are presented as numbers and percentages for categorical values. Continuous
variables are presented as mean and standard deviation or median and interquartile range. Differences in
baseline characteristics between cohorts were compared with analysis of variance for continuous variables
and Pearson chi-square for categorical variables.

The percentage of new permanent pacemaker implantation was determined excluding patients with a
pacemaker at baseline. Re-hospitalization rates for EXPRES and R-EXPRES cohorts were compared with
the standard cohort using Fisher’s exact test. Total LOS for R-EXPRES patients was compared with LOS for
standard patients using Mann-Whitney U test.

RESULTS
From July 2017 to July 2019, 412 patients underwent successful implantation of at least one THV and had
complete 30-day follow-up. A routine discharge pathway was followed in 269 patients (65%), while 121
patients were included in the R-EXPRES cohort (29%) and 22 in the EXPRES cohort (5%).

Baseline and procedural characteristics
Baseline characteristics stratified for discharge pathway are depicted in Table 2. In brief, EXPRES patients
trended younger, were less symptomatic according to the New York Heart Association Classification (P <
0.01), and at lower estimated surgical risk according to Euroscore II (P < 0.01) and STS-score (P < 0.02)
[Table 2].

Procedural characteristics are shown in Table 3. The vast majority of patients were treated through the
femoral artery (93%, 95%, and 100% for the standard, R-EXPRES, and EXPRES cohorts, respectively).
Almost all patients were treated under local anesthesia. There was an equal share of embolic protection use
in all cohorts (44%, 45%, and 50% for the standard, R-EXPRES, and EXPRES cohorts, respectively, P = 0.86).

The share of balloon-expandable valves was higher in the EXPRES cohort as compared to the standard and
R-EXPRES cohorts (73% vs. 41% and 36%; P < 0.01). Although EXPRES patients were treated with either an
Edwards Sapien 3 or Acurate NEO valve per protocol, three patients underwent TAVI with the self-
expanding Evolut Pro/R platform (Medtronic, Fridley, Minnesota): one because of inclusion in a registry on
bicuspid valves and two due to small caliber femoral arteries [Table 3].

Clinical outcomes
Clinical outcomes are shown in Table 4. In total, seven (2%) patients died, one in the R-EXPRES cohort and
six in the standard cohort. There were no deaths, stroke/transient ischemic attack, or access site