BATMAN-facilitated ViMAC TMVR achieved 100% technical success without significant LVOT obstruction, though 30-day all-cause mortality was 36.4%.
Case Report
Is BATMAN-facilitated ViMAC TMVR feasible and safe in patients with severe mitral annular calcification?
BATMAN-facilitated ViMAC TMVR is technically feasible and prevents LVOT obstruction, but is associated with substantial early mortality, requiring careful patient selection.
BACKGROUND: Severe mitral annular calcification (MAC) complicates transcatheter mitral valve replacement (TMVR) by increasing left ventricular outflow tract (LVOT) obstruction risk. Balloon-assisted translocation of the anterior mitral leaflet (BATMAN) may reduce this risk, but experience with native valve-in-mitral annular calcification (ViMAC) remains limited. CASE SUMMARY: ) underwent BATMAN-facilitated ViMAC TMVR. Technical success was 100%, with no valve embolization or significant LVOT obstruction; paravalvular leak closure was required in 27.3%. Predischarge transmitral gradient was 5.4 ± 1.7 mm Hg; 30-day all-cause and cardiac mortality rates were 36.4% and 18.2%, respectively. DISCUSSION: Published BATMAN reports support feasibility, but ViMAC-specific data are limited. This series addresses high-risk anatomy with few alternatives and substantial early hazard. TAKE-HOME MESSAGES: BATMAN-facilitated ViMAC TMVR appears feasible without technique-related adverse events, but early mortality remains substantial. Use requires multidisciplinary selection and shared decision-making.
“Traditionally, the LAMPOON technique and its various iterations has been used to enable TMVR in patients at high risk of LVOT obstruction; however, this technique has a steep learning curve and is technically more challenging and time-consuming. The findings from this study highlight that BATMAN may be considered as an alternative to LAMPOON associated with excellent efficacy and safety, particularly for ViR and ViV procedures, providing another option for physicians.”
Giacaman et al. (Wed,) conducted a case report in Severe mitral annular calcification (MAC). BATMAN-facilitated ViMAC TMVR was evaluated on Technical success. BATMAN-facilitated ViMAC TMVR achieved 100% technical success without significant LVOT obstruction, though 30-day all-cause mortality was 36.4%.
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