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van Wiechen et al. Mini-invasive Surg 2022;6:1 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.96

Original Article Open Access

Referring hospital involvement in early discharge

post transcatheter aortic valve implantation: the
TAVI (R-) EXPRES program

Maarten P. van Wiechen, Marjo J. de Ronde-Tillmans, Nicolas M. Van Mieghem

Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam 3015 GD, The Netherlands.
Correspondence to: Prof. Nicolas M. Van Mieghem, Department of Interventional Cardiology, Erasmus University Medical
Center, Office Nt 645, Dr Molewaterplein 40, Rotterdam 3015 GD, The Netherlands. E-mail: n.vanmieghem@erasmusmc.nl
How to cite this article: van Wiechen MP, de Ronde-Tillmans MJ, Van Mieghem NM. Referring hospital involvement in early
discharge post transcatheter aortic valve implantation: the TAVI (R-) EXPRES program. Mini-invasive Surg 2022;6:1.
https://dx.doi.org/10.20517/2574-1225.2021.96

Received: 18 Aug 2021 First Decision: 17 Sep 2021 Revised: 30 Oct 2021 Accepted: 11 Nov 2021 Published: 6 Jan 2022
Academic Editors: Andrea Scotti, Giulio Belli Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Aim: Over the past decade, transcatheter aortic valve implantation (TAVI) has matured into a valid treatment
strategy for elderly patients with severe aortic stenosis. TAVI programs will grow with its adoption in low-risk
patients. The aim of this study was to evaluate safety and feasibility of early discharge protocols, either home or
back to a referring hospital.

Methods: Consecutive patients undergoing TAVI between July 2017 and July 2019 were stratified into three
discharge pathways from TAVI center: (1) early home (EXPRES); (2) early transfer to referring hospital (R-
EXPRES); and (3) routine discharge (standard). Baseline, procedural, and 30-day outcomes were prospectively
collected and compared per discharge pathway.

Results: In total, 22 (5%) patients were enrolled in the EXPRES cohort [median age 78 (IQR: 73-81); mean Society
of Thoracic Surgeons (STS) 2.4% ± 1.5%], 121 (29%) in the R-EXPRES cohort [median age 81 (IQR: 77-84); mean
STS 4.3% ± 2.8%], and 269 (65%) in the routine discharge cohort [median age 80 (IQR: 75-85); mean STS 4.4%
± 3.1%]. EXPRES patients trended to be younger (P = 0.13) and had lower STS (P = 0.02). Early clinical outcome
was similar through the different pathways including re-hospitalization rate. Median length of stay was one day
longer for R-EXPRES vs. routine discharge patients [5 (IQR: 4-7) vs. 4 (IQR: 3-6); P < 0.01]. Median length of stay
(LOS) was two days (IQR: 1-3 days) for EXPRES patients.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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