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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 7 of 11

Figure 1. Re-hospitalization rate stratified by cohort.

and one patient refused transfer. Of the unresolved complications, five had vascular or access-site related
complications, two had unexplained neurological symptoms, and two had temporary pacemaker wires and
went directly home after implantation of a permanent pacemaker in the valve center. One patient was
discharged to the referring hospital but transferred back to the valve center after a complicated pacemaker
implantation.

The remaining 105 patients (88%) went to the referring hospital. Median LOS for R-EXPRES patients was
longer than that in the reference cohort [5 (IQR: 4-7) vs. 4 (IQR: 3-6); P < 0.01]. Median LOS in EXPRES
was two days (IQR: 1-3 days).

DISCUSSION
TAVI thrives on meticulous patient selection, even more so when considering patients for early discharge.
This single-center experience illustrates three discharge pathways including next day discharge from the
TAVI site either home or to the referring hospital. The main findings of this single center experience with
three different post-TAVI pathways can be summarized as follows: (1) a significant number of patients can
be safely discharged home (EXPRES) or to the referral hospital (R-EXPRES) if proper logistics and/or social
support are in place; (2) heart failure, conduction disorders, and infections were the main reasons for
hospital re-admission; and (3) further data and experience exchange may streamline and reduce the LOS in
the referral hospitals.

Early discharge
Changing patient phenotype to younger age with a more active and independent lifestyle demands an
appropriate discharge policy. Over time, there has been a gradual reduction in LOS after TAVI, irrespective
of surgical risk . The implementation of early discharge protocols as described in the Vancouver 3M and
[14]
FAST-TAVI registries will further reduce LOS after TAVI.

Patients in the Vancouver 3M and FAST-TAVI registries on early discharge protocols were still elderly [84
(IQR: 78-87) and 81.4 (SD ± 6.0), respectively] [9,10] . Due to cultural differences and geographical differences