[en] [en] OBJECTIVE: To assess the technical feasibility of a new method of educational training, based on audio-video (AV) communication between an interventional cardiologist and the cath lab staff members in one location and a remote expert proctor.
METHODS: Overall, 9 patients underwent a percutaneous coronary intervention (PCI) targeting a chronic total occlusion (CTO) between June 2021 and January 2022 at a single Belgian center using the virtual proctoring approach. For this assessment, the strategic planning of the CTO PCI and all the decisions throughout the intervention were the responsibility of the proctor. The operator was guided via an AV link, by the proctor throughout the procedure.
RESULTS: The operator performed each procedural step, guided by the remote proctor, who had continuous access to all relevant interventional details. No major adverse cardiac events (MACE) occurred during the index hospitalization or within 6 months follow-up.
CONCLUSIONS: A new method of virtual proctoring based on live AV communication is feasible, even in the case of highly complex CTO PCI procedures. This strategy also appears safe and may provide the patient the benefit of incremental expertise. This approach is facilitated by advances in AV communication and allows physicians to share expertise irrespective of location. It could increase global interaction between colleagues and facilitate sharing of knowledge, which are both key aspects in the development of CTO PCI. This preliminary experience could serve as a basis for future large studies to study the potential role and benefits of virtual proctoring for complex CTO PCI procedures.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Ungureanu, Claudiu ; Université de Mons - UMONS ; Jolimont Hospital, La Louvière, Belgium. Email:ungureanu.claudiu@ymail.com
Yamane, Masahisa; Saitima St. Luke's International Hospital, Tokyo, Japan
Kayaert, Peter; Ghent University Hospital, Ghent, Belgium
Knaapen, Paul; Heart Center of the Amsterdam University Medical Centers, Amsterdam, the Netherlands
Mashayekhi, Kambis; Heart Center Lahr/Baden , Lahr/Schwarzwald, Germany
Alaswad, Khaldoon; Edith and Benson Ford Heart and Vascular Institute, Henry Ford Hospital, Henry Ford Health System, Wayne State University, Detroit, Michigan
Spratt, James C; St. George's University Hospital NHS Foundation Trust, London, UKn
Gasparini, Gabriele Luigi; Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
Dens, Joseph; ZOL, Genk, Belgium
Lepièce, Caroline; Jolimont Hospital, La Louvière, Belgium
Carlier, Stéphane ; Université de Mons - UMONS > Faculté de Médecine et de Pharmac > Service de Cardiologie
Brilakis ES, Banerjee S, Karmpaliotis D, et al. Procedural outcomes of chronic total occlusion percutaneous coronary intervention. J Am Coll Cardiol Intv 2015;8: 245–53. doi:10.1016/j.jcin.2014.08.014
Sapontis J, Christopoulos G, Grantham JA, et al. Procedural failure of chronic total occlusion percutaneous coronary intervention: insights from a multicenter US registry. Catheter Cardiovasc Interv 2015;85:1115–22. doi:10.1002/ccd.25807
Galassi AR, Boukhris M, Azzarelli S, et al. Percutaneous coronary revascularization of chronic total occlusions: A novel predictive score of technical failure using advanced technologies. JACC Cardiovasc Interv. 2016;9(9):911–22. doi:10.1016/j.jcin.2016.01.036
Karmpaliotis D, Lembo N, Kalynych A, et al. Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes. Catheter Cardiovasc Interv. 2013;82(1):1-8. doi:10.1002/ccd.24387
Riley RF, Henry TD, Kong JA, et al. A CHIP fellow's transition into practice: Building a complex coronary therapeutics program. Catheter Cardiovasc Interv. 2020;96(5):1058-1064. doi:10.1002/ccd.28599
Sharma V, Jadhav ST, Harcombe AA, et al. Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions. Open Heart. 2015;2(1):e000228. Published 2015 Mar 28. doi:10.1136/openhrt-2014-000228
Yamamoto M, Tsuchikane E, Kagase A, et al. Novel proctorship effectively teaches interventionists coronary artery chronic total occlusion lesions. Cardiovasc Revasc Med. 2018;19(4):407-412. doi:10.1016/j.carrev.2017.10.015
Żelazowska-Chmielińska K, Wąsek W, Ferenc M, Kamiński B, Przerwa T, Krzesiński P. Influence of a long-term proctoring process on the effectiveness of chronic total occlusion percutaneous coronary interventions. Kardiol Pol. 2022;80(4):445-451. doi:10.33963/KP.a2022.0042
Wu EB, Brilakis ES, Mashayekhi K, et al. Global chronic total occlusion crossing algorithm: JACC state-of-the-art review. J Am Coll Cardiol. 2021;78(8):840-853. doi:10.1016/j.jacc.2021.05.055
Morino Y, Abe M, Morimoto T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4(2):213-221. doi:10.1016/j.jcin.2010.09.024
Ybarra LF, Rinfret S, Brilakis ES, et al. Definitions and clinical trial design principles for coronary artery chronic total occlusion therapies: CTO-ARC consensus recommendations. Circulation. 2021;143(5):479-500. doi:10.1161/CIRCULATIONAHA.120.046754
Urban P, Mehran R, Colleran R, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention. Circulation. 2019;140(3):240-261. doi:10.1161/CIRCULATIONAHA.119.040167
Chandiramani R, Cao D, Nicolas J, Mehran R. Contrast-induced acute kidney injury. Cardiovasc Interv Ther. 2020;35(3):209-217. doi:10.1007/s12928-020-00660-8
Ungureanu C, Gasparini GL, Aminian A, et al. RailTracking: A novel technique to overcome difficult anatomy during transradial approach. J Invasive Cardiol. 2022;34(11):E757-E762.
Artsen AM, S Burkett L, Duvvuri U, Bonidie M. Surgeon satisfaction and outcomes of tele-proctoring for robotic gynecologic surgery. J Robot Surg. 2022;16(3):563-568. doi:10.1007/s11701-021-01280-x
Het M. Surgical proctoring for gynecologic surgery. Obstet Gynecol. 2014;123(2 Pt 1):349-352. doi:10.1097/AOG.0000000000000076
Burgess LP, Syms MJ, Holtel MR, Birkmire-Peters DP, Johnson RE, Ramsey MJ. Telemedicine: teleproctored endoscopic sinus surgery. Laryngoscope. 2002;112(2):216-219. doi:10.1097/00005537-200202000-00003
Zorn KC, Gautam G, Shalhav AL, et al. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol. 2009;182(3):1126-1132. doi:10.1016/j.juro.2009.05.042