Transcatheter closure of patent ductus arteriosus (TC-PDA) has become a safe alternative to surgical ligation in premature infants. Current guidelines recommend an experienced onsite physician proctoring initial cases, as procedural complications may have catastrophic consequences. Appropriate onsite mentoring is difficult in remote centers.

La Réunion University Hospital is a French congenital heart disease (CHD) center located 10.000-km away from mainland France, without expert TC-PDA proctor within close distance. Cases were performed with the remote mentoring of an echographer and an interventionist proctor who were conferenced into the operating room using Medinbox, a secure platform allowing bidirectional audio communication and real-time high-quality streaming of imaging guidance modalities ( Fig. 1 ). A retrospective study was conducted to report our experience in tele-proctored TC-PDA in < 2000-grams infants between 2022 and 2025.

Tele-proctored TC-PDA was performed in 11 symptomatic infants (median gestational age: 26 weeks [Q1–Q3: 25–27], birth weight: 850 grams [Q1–Q3: 715–920]), at a procedural age of 25 days [Q1–Q3: 22–27] and weight of 1200 grams [Q1–Q3: 1000–1450], including an 880-grams and a 950-grams infant under high-frequency jet ventilation. PDAs were large (diameter: 3.6 mm [Q1–Q3: 2.9–3.8]), with a length of 7 mm [Q1–Q3: 6–9], and hemodynamically significant according to clinical and echocardiographic criteria. They were closed using an 4/2 Amplatzer Piccolo Occluder (APO, Abbott, USA) in 5 patients, a 5/2 APO in 5, and a 6-mm Amplatzer Vascular Plug-II (Abbott, USA) in 1.Procedural success was achieved in 11/11 cases. Postprocedural echocardiography showed non-increased LPA and DAo flow velocities (Vmax: 1.6 m/s [Q1–Q3: 1.4–1.8] and 1.1 m/s [Q1–Q3: 1.0–1.3], respectively). Patients were extubated within 5 days [Q1–Q3: 2–7]. One patient died 2 months after the procedure because of a procedure/device unrelated sepsis. After a median follow-up of 14 months [Q1–Q3: 4–22], no late reintervention was required in the 10 survivors, who all had no residual shunt on last visit.

Our report demonstrates that tele-proctoring is feasible using an integrated digital operating room technology and may be safely applied for high-risk neonatal cardiac interventions. This carries major implications, including rapid dissemination and sharing of knowledge for innovative technical procedures helping patients across the globe.