BATMAN Procedure in Toledo, Ohio: A New Option for Failing Mitral Valve Replacements
- Jul 19
- 3 min read
Toledo Cardiology has performed the first BATMAN procedure in Northwest Ohio, bringing a specialized minimally invasive valve treatment to patients in Toledo, Maumee, Perrysburg, Sylvania, Bowling Green, Findlay, and the surrounding Southeast Michigan border region. If you have a bioprosthetic mitral valve (an artificial valve made from biological tissue, often referred to as a pig valve) that is no longer functioning properly, this procedure may allow you to receive a new valve without open-heart surgery, right here in Toledo at Mercy Health St. Vincent Medical Center.
WHAT IS THE BATMAN PROCEDURE?
BATMAN stands for Balloon-Assisted Translocation of the Mitral Anterior Leaflet. It is a catheter-based technique performed as part of Transcatheter Mitral Valve Replacement (TMVR), meaning the new valve is delivered through a thin, flexible tube threaded through a blood vessel rather than through a surgical incision in the chest.
The procedure addresses a specific and serious complication that can occur during TMVR: left ventricular outflow tract (LVOT) obstruction (a blockage in the channel through which blood exits the heart's main pumping chamber). When an old bioprosthetic mitral valve is failing and a new valve is placed inside it, the leaflet (the flap of tissue that opens and closes the valve) can be pushed toward this outflow channel, restricting blood flow out of the heart. Without correction, this obstruction can be life-threatening.
HOW THE PROCEDURE WORKS
The BATMAN technique modifies the existing leaflet before the new valve is implanted, eliminating the obstruction risk. The steps are as follows.
Transseptal access: The cardiologist advances a catheter through the septum (the wall separating the heart's two upper chambers), reaching the mitral valve from inside the heart.
Electrocautery perforation: A 0.014-inch wire carrying high-energy electrical current (electrocautery) is used to perforate and cut through the anterior mitral leaflet (the front-facing flap of the valve), freeing it from its obstructing position.
Balloon dilation: A balloon, typically 14 mm in diameter, is inflated to push the leaflet tissue away from the outflow tract, creating a clear path for blood to exit the heart.
New valve implantation: Once the obstruction risk is resolved, the new transcatheter heart valve is placed inside the old valve structure, a technique known as valve-in-valve or valve-in-ring replacement.
One practical advantage of the BATMAN approach is that it relies entirely on standard equipment already available in a cardiac catheterization laboratory. No specialized or costly devices are required, making it an accessible option compared to some alternative techniques. Early studies have demonstrated high technical success rates in preventing LVOT obstruction using this method.
WHO IS A CANDIDATE?
The BATMAN procedure is primarily used for patients with failing bioprosthetic mitral valves who need a valve-in-valve or valve-in-ring replacement. It may also be appropriate in certain cases involving severe mitral annular calcification (MAC), a condition in which calcium deposits form in the ring of tissue surrounding the mitral valve, complicating standard valve replacement. Your cardiologist will evaluate your imaging, valve anatomy, and overall cardiac function to determine whether this approach is right for you.
Patients who have previously undergone procedures such as transcatheter valve replacement for aortic stenosis in Toledo will recognize the shared principle: delivering a new valve through a catheter rather than open surgery. The BATMAN technique extends that same minimally invasive philosophy to the mitral position. For patients managing additional cardiovascular conditions, our posts on heart failure care in Toledo and cardiac catheterization in Toledo provide further context on how we approach complex cardiac disease at Toledo Cardiology.
THE TOLEDO CARDIOLOGY TEAM BEHIND THIS MILESTONE
This first-in-Northwest-Ohio procedure was performed by Drs. Taleb, Noman, Debardino, and S. Alo at Mercy Health St. Vincent Medical Center in Toledo. Toledo Cardiology is proud to bring this level of advanced structural heart care to our community, so that patients across Northwest Ohio and Southeast Michigan do not need to travel to a distant academic center to access it.
Schedule Your Appointment in Toledo
If you or a family member has a bioprosthetic mitral valve that may be failing, contact Toledo Cardiology to schedule a structural heart consultation. Our team will review your history, imaging, and valve function to determine whether the BATMAN procedure or another minimally invasive option is appropriate for your situation. We see patients from Toledo, Perrysburg, Sylvania, Maumee, Bowling Green, Findlay, and the Southeast Michigan area. When you call, our staff can guide you on scheduling, paperwork, and parking at our Toledo locations.
