key: cord-0817600-h3thu9b1
authors: Arslan, Fatih; Gerckens, Ulrich
title: Virtual support for remote proctoring in TAVR during COVID‐19
date: 2021-02-01
journal: Catheter Cardiovasc Interv
DOI: 10.1002/ccd.29504
sha: f69294a1315c5f1248336d3bb2470ce4f04f7d03
doc_id: 817600
cord_uid: h3thu9b1

OBJECTIVES: The current report describes a single operator's experience of the first use of smartglass technology as a facilitator of virtual support during TAVR proctoring. BACKGROUND: Restricted gatherings and containment measures during the ongoing COVID‐19 pandemic have a major impact on daily clinical practice. Interaction between peers is crucial in science, clinical practice, and education. In addition, there is also a growing importance of proctoring in interventional cardiology for structural heart disease. Virtual support may facilitate the wide implementation of remote proctoring. METHODS: A collaboration between a smartglass provider (Rods & Cones) and self‐expandable transcatheter aortic heart valve system (Medtronic) was initiated and tested extensively prior to TAVR procedures. Two cases were randomly selected for remote support. The light‐weight smartglass consisted of a full HD central camera, a 720p ×5 optical zoom camera, built‐in LED light, speaker and earphone jack, and an external visor to project data in a nonobstructive manner in the operators' view. RESULTS: Preprocedural detailed discussion of the cases between the proctor and the operator occurred via teleconferencing. Successful procedural virtual support was determined by the presence of a session coordinator, high quality of the central camera, high‐speed and stable wireless internet connection. Limitations were the relative discomfort of the earpieces, discordance between the central and zoom camera and the absence of visual fixation during head motions. CONCLUSION: In a highly complex and demanding context such as TAVR, remote proctoring by means of virtual support is feasible and efficacious.

that the supervisor is nearby to assist, advice or correct the apprentice. In a previous report in this Journal, alternative methods for physical heart team meetings were presented. It was shown how technological advances can ensure the quality of heart team meetings while respecting the measures for mitigating risks of spread. 3 In this article, we describe a virtual support device, with its advantages and limitations, that was used during proctoring for transcatheter aortic valve replacement (TAVR) procedures.

The online proctoring solution was provided by a collaborative initiative between Rods&Cones (Virtual Support hardware and application;

Amsterdam, the Netherlands) and Medtronic (Evolut transcatheter aortic heart valve system; MN).

The day prior to the TAVR procedure, the patients were discussed in detail between the proctor and the operator via teleconferencing.

Patient and clinical characteristics, anatomic assessment, potential hurdles or complications related to specific features of individual cases were critically reviewed and possible solutions and backstops were discussed.

The most relevant clinical characteristics are highlighted in Table 1 .

The integrated smartglass for virtual support consists of a full HD central camera and a 720p ×5 optical zoom camera. It has also a built-in LED light, built-in speaker, and plug-in earphone jack and an external visor to project images/videos without obstructing the operator's view ( Figure 1 ). The glasses are lightweight (70 g) and can be worn over a safety (leaded) goggle ( Figure 2 ). The smartglass is connected to the pocket unit that contains a battery pack and a smartphone. The application for virtual support is running on the smartphone either though a 4G or Wi-Fi internet connection. The pocket unit battery can last for at least 5 hr of active video connection, and can also be recharged during an active session.

Before starting the video call, the status of the remote expert is checked and the smartglass user is informed (on the visor) whether the remote expert is logged in. The application initiates a video call between the operator and the remote expert by focusing at the dedicated QR code which then translates into a command that triggers the session to be started. The remote expert is able to watch and follow the procedure together with the operator through the smartglass. The operator is able to communicate one-on-one with the remote expert through an ear-and microphone set plugged into the smartglass. In addition, written commands can be given that are projected in the visor ( Figure 3 ).

The active participation of a coordinator is shown to be crucial in the entire 

Technologies to improve or support the visual world are using devices that resemble eyeglasses. These so-called smartglasses are usually made of light-weight material and produced in one size or anatomic shape of the head. Hence, comfort in wearing these devices is usually suboptimal, Nevertheless, in an era of growing interest for proctoring among peers from different continents, virtual interactions are here to stay.

We would like to thank Dorien Peeters (technical consultant Structural Heart for Medtronic) and Bruno Dheedene (Founding Partner at

Rods & Cones) for their technical support.

COVID-19: the EU's response in the field of public health

Coronavirus disease (COVID-19) advice for the public

Heart team meetings during COVID-19

Surgeons use virtual reality to operate from different sides of the world

Longkankeroperaties kunnen preciezer door VR-bril

Fatih Arslan has no conflicts of interest to declare. Ulrich Gerckens is an international proctor for Medtronic.

https://orcid.org/0000-0001-6598-8599