Key result
Trans-septal BATMAN provides a step-by-step technique to prevent LVOT obstruction during TMVR.
Why the study?
Several approaches to reduce the risk of LVOT obstruction during TMVR have specific challenges including procedural complexity and invasiveness.
This guide outlines a simplified trans-septal approach to the BATMAN technique for preventing LVOT obstruction during TMVR, aiming to overcome the complexity and thoracotomy requirements of alternative methods.
A critical consideration when evaluating patients for transcatheter mitral valve replacement (TMVR) is the risk of left ventricular outflow tract (LVOT) obstruction. LVOT obstruction, arising from the displacement of the anterior mitral valve leaflet (AMVL) towards the interventricular septum (IVS), constitutes a catastrophic complication of TMVR. Several approaches have been developed to reduce the risk of LVOT obstruction. These methods include percutaneous Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN (LAMPOON),(1) alcohol septal ablation, septal scoring along midline endocardium (SESAME),(2) and Balloon-Assisted Translocation of the Mitral ANterior leaflet (BATMAN).(3) These techniques present specific challenges: LAMPOON and SESAME are associated with procedural complexity, alcohol septal ablation may yield variable outcomes, and transapical BATMAN (TA-BATMAN) requires thoracotomy.
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Seshiah et al. (2026) studied Left ventricular outflow tract (LVOT) obstruction in transcatheter mitral valve replacement (TMVR). Trans-Septal BATMAN (Balloon-Assisted Translocation of the Mitral ANterior leaflet) was evaluated. Trans-septal BATMAN is presented as a step-by-step technique to reduce the risk of left ventricular outflow tract obstruction during transcatheter mitral valve replacement.
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