Teleproctoring for Training in Structural Heart Interventions: Initial Real‐World Experience During the COVID‐19 Pandemic

Abstract

Background Proctoring represents a cornerstone in the acquisition of state‐of‐the‐art cardiovascular interventions. Yet, travel restrictions and containment measures during the COVID‐19 pandemic limited on‐site proctoring for training and expert support in interventional cardiology. Methods and Results We established a teleproctoring setup for training in a novel patent foramen ovale closure device system (NobleStitch EL, HeartStitch Inc, Fountain Valley, CA) at our institution using web‐based real‐time bidirectional audiovisual communication. A total of 6 patients with prior paradoxical embolic stroke and a right‐to‐left shunt of grade 2 or 3 were treated under remote proctorship after 3 cases were performed successfully under on‐site proctorship. No major device/procedure‐related adverse events occurred, and none of the patients had a residual right‐to‐left shunt of grade 1 or higher after the procedure. Additionally, we sought to provide an overview of current evidence available for teleproctoring in interventional cardiology. Literature review was performed identifying 6 previous reports on teleproctoring for cardiovascular interventions, most of which were related to the current COVID‐19 pandemic. In all reports, teleproctoring was carried out in similar settings with comparable setups; no major adverse events were reported. Conclusions Teleproctoring may represent a feasible and safe tool for location‐independent and cost‐effective training in a novel patent foramen ovale closure device system. Future prospective trials comparing teleproctoring with traditional on‐site proctoring are warranted.

Keywords

• COVID‐19
• patent foramen ovale
• PFO closure
• remote proctoring
• teleproctoring