Transseptal BATMAN Procedure Utilizing a Simplified Technique: "Single Wire Approach for Traversing Tissue" (SWATT)

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Left Ventricular Outflow Tract (LVOT) obstruction is a significant risk during Transcatheter Mitral Valve Replacement (TMVR).
• Existing methods to prevent LVOT obstruction, such as LAMPOON, alcohol septal ablation, SITRAL, and Balloon Assisted Translocation of Mitral Anterior leaflet (BATMAN), have limitations including complexity and inconsistent results.

Purpose of the Study:

• To introduce and describe a simplified technique, the Single Wire Approach for Traversing Tissue (SWATT), for facilitating transcatheter procedures.
• To demonstrate the utility of SWATT in a trans-septal Balloon Assisted Translocation of Mitral Anterior leaflet (BATMAN) procedure to mitigate Left Ventricular Outflow Tract obstruction risk.

Main Methods:

• Description of the Single Wire Approach for Traversing Tissue (SWATT) technique.
• Utilization of the commercially available VERSACROSS transeptal system for the procedure.
• Application of SWATT to a trans-septal BATMAN procedure to navigate valve leaflets and cardiac tissue.

Main Results:

• The SWATT technique simplifies the trans-septal BATMAN procedure.
• It minimizes the need for multiple wire exchanges, snares, and high-energy electrocautery.
• This simplification aims to overcome the procedural complexity that has hindered widespread adoption of existing techniques.

Conclusions:

• The Single Wire Approach for Traversing Tissue (SWATT) offers a simplified method for complex transcatheter mitral valve interventions.
• SWATT facilitates trans-septal BATMAN procedures, potentially reducing the risk of Left Ventricular Outflow Tract obstruction.
• This simplified approach may enhance the adoption and applicability of preventative strategies for TMVR complications.