Expanding Transcatheter Mitral Valve Replacement Eligibility for ViMAC With a Streamlined BATMAN Leaflet Modification Technique

Q: What are the key findings of this study?

BATMAN-facilitated transcatheter mitral valve replacement achieved a 100% technical success rate in 11 patients with severe mitral annular calcification at prohibitive risk of LVOTO.

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Severe mitral annular calcification (MAC) requiring transcatheter mitral valve replacement (n=11). Intervention: BATMAN-facilitated transcatheter mitral valve replacement. Primary outcome: Technical success (successful leaflet modification followed by THV deployment without significant LVOTO, LVOT mean gradient <10 mm Hg).

Q: What does this research mean for the field?

A streamlined BATMAN leaflet modification technique expands eligibility for transcatheter mitral valve replacement and achieves high technical success without significant left ventricular outflow tract obstruction in patients with valve-in-mitral annular calcification. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Chantal Y. Asselin; Gennaro Giustino; Alessandro Beneduce

doi:10.1016/j.jaccas.2026.109556

August 1, 2026JACC Case ReportsOpen Access

Expanding Transcatheter Mitral Valve Replacement Eligibility for ViMAC With a Streamlined BATMAN Leaflet Modification Technique

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Key result

BATMAN-facilitated TMVR achieves 100% technical success in prohibitive-risk MAC patients.

n=11

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Valve-in-MAC (ViMAC) represents a high-risk scenario for TMVR with increased mortality and complications, and strategies to expand eligibility and reduce LVOTO risk are needed.

PICO

P

Population

11 consecutive patients with severe mitral annular calcification at prohibitive risk of left ventricular outflow tract obstruction undergoing BATMAN-facilitated transcatheter mitral valve replacement.

I

Intervention / Comparator

BATMAN-facilitated transcatheter mitral valve replacement

O

Primary Outcome

Technical success (successful leaflet modification followed by THV deployment without significant LVOTO, LVOT mean gradient <10 mm Hg)

Limitations

High 30-day all-cause mortality rate (36.4%) reflecting advanced disease and significant burden of comorbidities.
Significant procedural complications including paravalvular leak requiring closure (27.3%) and pericardiocentesis (18.2%).
Risk of unpredictable propagation of the anterior mitral leaflet laceration in the absence of a rigid structure.
Retrospective case series with a very small sample size.

Abstract

[Figure: see text]

Discussion

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Cite This Study

Asselin et al. (2026) conducted an editorial in Severe mitral annular calcification (MAC) requiring transcatheter mitral valve replacement (n=11). BATMAN-facilitated transcatheter mitral valve replacement was evaluated on Technical success (successful leaflet modification followed by THV deployment without significant LVOTO, LVOT mean gradient <10 mm Hg). BATMAN-facilitated transcatheter mitral valve replacement achieved a 100% technical success rate in 11 patients with severe mitral annular calcification at prohibitive risk of LVOTO.

synapsesocial.com/papers/6a9f9c032c4b2bcfa3f3d02d https://doi.org/10.1016/j.jaccas.2026.109556

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Expanding Transcatheter Mitral Valve Replacement Eligibility for ViMAC With a Streamlined BATMAN Leaflet Modification Technique

Figures

PICO

Limitations

Abstract

Discussion

Cite This Study

Expanding Transcatheter Mitral Valve Replacement Eligibility for ViMAC With a Streamlined BATMAN Leaflet Modification Technique

Figures

PICO

Limitations

Abstract

Discussion

Cite This Study

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