How Yale doctors used a balloon in surgery to treat heart issue

CT Insider – Tuesday, March 11, 2025
By Cris Villalonga-Vivoni

With the help of a long, flexible tube and a balloon, surgeons at Yale New Haven Health Heart & Vascular Center have a new tool in their cardiovascular treatment toolbox to help patients with severe heart issues.

Balloon-assisted translocation of the mitral anterior leaflet, also known as the BATMAN, is a type of procedure meant as a less invasive way to treat severe regurgitation between the heart chambers in patients who are ineligible for open heart surgery or other traditional treatments due to being high risk.

“These are patients that before we had these more innovative, less invasive approaches, the options were either a high-risk surgery or nothing, kind of continued medical management. (BATMAN) has really opened up a set of treatment avenues for patients that before were felt to just be too sick for traditional surgery,” said Dr. Amit Vora, the director of the Transcatheter Mitral Valve program at Yale and one of the lead surgeons who helped perform the procedure in Connecticut for what is believed to be the first time.

The mitral valve is a one-way path between the upper and lower left heart chambers that opens and closes to direct oxygenated blood from the lungs into the heart and out to the rest of the body, said Dr. Prashanth Vallabhajosyula, surgical director of the Aortic Institute at Yale New Haven Health Heart & Vascular Center.

A typical valve problem called mitral regurgitation happens when the valve works improperly, causing the pumped blood to go back into the heart rather than out to the body. Vallabhajosyula said the severity of the condition varies from patient to patient, with some being able to manage the condition with medication while others need more invasive procedures.

So far, the oldest “mainstay operative treatment therapy” to treat mitral regurgitation was open heart surgery in which surgeons would repair the valve themselves, Vallabhajosyula said. Over the years, less invasive surgical approaches have been developed to repair or replace the mitral valve through “catheter-based techniques,” which involve tapping into the major arteries and the heart with a long, flexible tube inserted in the leg.

Valves repaired through open heart surgery, however, “may not last forever,” leading to leaking across the heart chambers, Vora said. In addition, transcatheter valve replacements can sometimes push the old heart valve to the side in a way that may obstruct blood from pumping to the heart’s main chamber.

Vora said the BATMAN technique, one of the newest developments in the rapidly growing field, mitigates those risks and provides an alternative for patients. It works by inserting a catheter with a deflated balloon into the blood vessels of a patient’s leg and the impacted heart valve. Surgeons inflate the balloon to make a permanent tear in between the heart chambers by inflating the balloon once in position.

By intentionally tearing the valve, Vora said, it allows the blood to flow unimpeded and mitigates the risk of the traditional procedures.

“It’s a procedure that, I think, honestly speaks to the ingenuity of the people that initially came up with it because there’s no kind of dedicated tools for it or anything like that,” Vora said. “We’re basically repurposing tools off the shelf that have been developed for other purposes and refashion them in a way that allows us to perform procedures like this safely and effectively for patients.”

Although Yale doctors didn’t develop the procedure, Vallabhajosyula said their team of surgeons and medical providers were the first to perform it in Connecticut.

Vallabhajosyula said the primary benefit of BATMAN is how many people can potentially benefit from this new approach to care who may not have had the options before with the help of a “multi-disciplinary team.”

Patients eligible for BATMAN fall into a slim category where complex biological challenges, comorbidities and other conditions prevent them from receiving the traditional treatments for their heart condition, like open-heart surgery.

The first patient, a woman in her 70s, was experiencing symptoms from the mitral regurgitation that was impacting her life, like causing shortness of breath. Vallabhajosyula said she was discharged two days after BATMAN was performed and has been doing great since.

“Their recovery is very fast because they’re not getting any big open operations. So patients are up out of bed the next day and they go home in a couple of days,” he said. “It has a significant impact on their quality of life because it not only addresses their immediate day-to-day symptoms of shortness of breath…potentially prevents heart failure episodes, which can directly translate to improving their survival.”

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