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

Table 4. Clinical outcomes at 30 days follow-up
Clinical outcomes Standard R-EXPRES EXPRES Total
n = 269 n = 121 n = 22 n = 412
All-cause mortality 6 (2) 1 (1) 0 (0) 7 (2)
Stroke 6 (2) 2 (2) 0 (0) 8 (2)
Transient ischemic attack 4 (2) 1 (1) 0 (0) 5 (1)
Access site complication 27 (10) 10 (8) 0 (0) 37 (9)
Life-threatening bleeding 7 (3) 8 (7) 0 (0) 15 (4)
Major bleeding 11 (4) 4 (3) 0 (0) 15 (4)
Minor bleeding 16 (6) 3 (3) 1 (5) 20 (5)
New permanent pacemaker i 42 (18) 20 (18) 1 (5) 63 (17)
- Implanted at valve center 11 (55)
- Implanted at referring hospital 9 (45)

(I)CCU stay
- No (I)CCU-stay 73 (27) 35 (29) 7 (32) 115 (28)
- < 24 h 163 (61) 72 (60) 14 (64) 249 (60)
- 24-48 h 23 (9) 9 (7) 1 (4) 32 (8)
- ≥ 48 h 9 (3) 4 (3) 0 (0) 14 (3)
ii ii
Median length of stay (total) 4 [3-6] 5 [4-7] 2 [1-3] 5 [3-6]
- Length of stay at valve center 1 [1-2]
- Length of stay at referring hospital 4 [3-5]
Re-hospitalization 19 (7) iii,iv 12 (10) iii 3 (14) iv 34 (8)
- For heart failure 3 (1.1) 2 (1.7) 1 (4.5) 6 (1.5)
- For conduction abnormalities 2 (0.7) 4 (3.3) 0 (0) 6 (1.5)
- Infection 9 (3.3) 2 (1.7) 2 (9.1) 13 (3.2)
- Other reasons 5 (1.8) 4 (3.3) 0 (0) 9 (2.2)

i
Categorical variables are presented as numbers (percentage). Continuous variables are presented as median (IQR). Pacemakers at baseline were
ii iii iv
excluded; P < 0.01; P = 0.45; P = 0.23.
The new permanent pacemaker implantation rate was 17% in the total cohort. In the R-EXPRES cohort, 20
patients (18%) required a new permanent pacemaker; 45% of the pacemakers were implanted in the
referring hospital, while 55% of pacemakers were implanted at the heart valve center. One EXPRES patient
needed a permanent pacemaker.

Although overall numbers were low, rates of re-hospitalization at 30 days for the R-EXPRES and EXPRES
cohort were not different from the standard cohort (10% vs. 7%, P = 0.45, and 14% vs. 7%, P = 0.23,
respectively). Twelve R-EXPRES patients (10%) were re-hospitalized, four because of conduction disorders,
two because of heart failure, two because of infections, and four for various reasons (among them, two
patients who collapsed without documented conduction disorders during telemetric observation). All four
patients who were re-hospitalized because of conduction disorders required a permanent pacemaker. Three
EXPRES patients were re-hospitalized: two patients required IV antibiotics (one because of pneumosepsis,
the other because of a pacemaker lead infection) and one patient was readmitted due to heart failure. All
three recovered [Figure 1].

R-EXPRES cohort
Of the 121 patients included in the R-EXPRES cohort, 14 patients (12%) did not go to the referring hospital.
There was one intra-procedural death (hemodynamic collapse due to tamponade, unsuccessful
resuscitation), three were discharged home because of quick recovery, nine faced unresolved complications,