BATMAN-Savior or vigilante?

BATMAN is a new technique to prevent left ventricular outflow tract (LVOT) obstruction from transcatheter mitral valve replacement (TMVR) by deploying the transcatheter heart valve from the apex through a perforation of the anterior mitral valve leaflet. The risks of uncontrolled balloon dilatation of the anterior mitral valve leaflet include extension of the tear superiorly into the aorto-mitral curtain or laterally to avulse the trigone from the annulus. Percutaneous laceration of the anterior mitral leaflet, pre-emptive alcohol septal ablation, and transatrial leaflet resection are alternative strategies that prevent LVOT obstruction from TMVR.