‘Batman Technique’ Helped an Elderly Patient — And What It Means for Structural Heart Care
By Dr. Haresh Mehta, Director of Interventional Cardiology & Structural Heart Interventions at S.L. Raheja Hospital, Mahim – A Fortis Associate
Cutting-edge procedure successfully restores normal heart function, offering new hope for high-risk patients
The BATMAN procedure stands for Balloon Assisted Traversal, Modification, and New Valve Implantation; this is a specialized technique utilized in TMVR to avert a critical complication known as Left Ventricular Outflow Tract obstruction.
This technique is used for patients with severe heart valve problems, particularly those who are elderly or frail, patients for whom traditional open-heart surgery carries prohibitively high risks, and complex cases of patients who have already had one valve replacement surgery (like the elderly woman in the case) and whose replaced valve has narrowed again, requiring urgent intervention.
The Critical Risk of LVOT Obstruction
In positioning the new valve, the old mitral valve flap-the anterior leaflet-is pushed forward. This leaflet that has been pushed may block the outflow into another critical valve called the aortic valve, which is the Left Ventricular Outflow Tract. This blocking of outflow into the aortic valve disrupts the normal flow of blood from the heart through to the rest of the body and is life-threatening.
Dr. Haresh Mehta, Director of Interventional Cardiology & Structural Heart Interventions, S.L. Raheja Hospital, Mahim – A Fortis Associate
This is the risk that the BATMAN technique is required to proactively eliminate, enabling the TMVR to proceed safely. It involves echo-guided threading a wire across the predetermined leaflet and using sequentially increasing diameter (4 to 14 mm) balloons to modify and split the old mitral leaflets. This modification creates a clear pathway, ensuring that when the new valve is implanted, the aortic valve remains unobstructed and blood flow stays normal.
The primary goal of the BATMAN procedure is to modify the anterior mitral leaflet—one of the heart's mitral valve flaps—to ensure it does not block the blood's exit pathway (the LVOT) after a new prosthetic valve is implanted. Its focus is to cut that old, dangerous flap before the new valve goes in. This cut ensures the flap stays out of the way. It uses simple tools to make this safe cut: A special wire is pushed across the base of the flap, then a balloon is slid over the wire and inflated. Then the inflated balloon tears the flap exactly where the doctor wants it to, and the wall is then implanted into the torn leaflet to ensure complete translocation of the leaflet.
In addition, in this patient, the previously implanted surgical valve was also fractured to allow optimum expansion of the newly deployed valve and to ensure optimum performance of the newly deployed valve. The patient-who presented with breathlessness, with no improvement on medications-is recovering well and was discharged home within 48 hours, with no special post-surgical care required. This successful outcome underlines the transformative potential of the Batman technique in improving quality of life for elderly and high-risk patients. One important advantage of BATMAN is cost-effectiveness, since it employs equipment that is already widely available in the cath lab: simple wire and balloon. There is no need for additional high-cost devices.
The Batman technique has a big impact on treating high-risk patients, those with tricky anatomy where normal treatments are risky. Using this method, we've given new hope to patients whom doctors thought they couldn't help before. We keep pushing what's possible in treating heart problems in India.
This method is a game-changer in how we deal with complex heart valve diseases. The Batman technique helps high-risk patients who didn't have many options before. By putting the new valve in place while keeping blood flowing, we can give these patients a better life and fewer problems down the road.
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