Balloon-Assisted Anterior Mitral Leaflet Translocation for Valve-in-MAC Transcatheter Mitral Valve Replacement
Recommended Citation
Giacaman A, Kumar S, Engel P, Lee J, Fram G, O’Neill B, Frisoli T, Villablanca P. Balloon-Assisted Anterior Mitral Leaflet Translocation for Valve-in-Mac Transcatheter Mitral Valve Replacement. JACC Case Rep. 2026;109190.
Document Type
Article
Publication Date
8-26-2026
Publication Title
JACC Case Rep
Abstract
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: Eleven high-risk patients with symptomatic severe native mitral annular calcification (81.8% NYHA functional class III/IV; predicted neo-LVOT 196.3 ± 88.8 mm(2)) 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.
PubMed ID
42461176
Volume
31
Issue
34
First Page
109190
Last Page
109190
