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A team of specialists at the CHUS complete the second Canadian instance of a new heart surgery called BATMAN
By Bryan Laprise
Local Journalism Initiative
After multiple hours of preparation and arduous teamwork, a team led by cardiologist Étienne Couture at the Centre hospitalier universitaire de Sherbrooke (CHUS) successfully completed a new and complex procedure called BATMAN.
This technique (“Balloon-assisted translocation of a mitral anterior leaflet”) allows specialists to implant a mitral valve prosthesis through a catheter passing by the groin for patients that have a special anatomy which previous techniques didn’t allow for.
It was invited by Italian cardiologists in 2024 and was only completed once in Canada before the CHUS’ recent success, in Toronto. The Sherbrooke hospital thus became the second in the country and the first in Quebec to complete this new procedure.
Prior to the establishment of the BATMAN surgery, patients requiring the implant of a mitral valve prosthesis either had to undergo open heart surgery, which is much riskier, or have no treatment at all. So far, around 50 patients have undergone this operation, usually those that have already had an open heart surgery for which the risk of doing another is much greater, according to the specialist.
“The heart is a pump and blood travels in the heart through valves,” he explained during an interview. “The valves are composed of leaflets, which are like little doors that open to let the blood pass through and close to stop it from going back.”
According to Couture, previous techniques by catheter positioned the prosthesis between the leaflets of the old valve, making them stay in an “open” position.
“In certain patients which have very long leaflets, there’s a risk that being maintained in an open position would harm the flow of blood out of the heart,” he added.
Since they are not operating via open heart surgery, they can’t simply cut the leaflets to prevent the obstruction. The BATMAN technique instead positions the prosthesis inside one of the leaflets by making a hole.
“When we deploy the prosthesis, the leaflet that could’ve caused an obstruction to blood flow will automatically be moved away from the dangerous zone and the prosthesis will work properly,” Couture explained.
This new technique will allow more patients to be treated via catheter rather than open heart surgery. Compared to other catheter valve replacements, BATMAN is a complicated procedure, which took four hours to complete. Couture told The Record that the patient must be under anesthesia.
With the aging population Couture expects to have to do this operation more often. For now, he’s saying between two to four times a year at the CHUS but could go up to ten times in a few years.
The cardiologist pointed out that other catheter procedures, such as TAVI (transcatheter aortic valve implantation) takes between one hour to an hour and a half including setting up the patient to them leaving the operating room.
“However, there’s always the benefit of catheter interventions compared to open heart surgery. The patient will arrive on the eve or the morning of the procedure, and the following day, if all goes well, the patient can already go home,” explained Couture.
A team of ten specialists was involved in the carrying out of the procedure, which required some 60 hours of preparation, meetings with anesthesiologists, nurses, perfusionists, medical imaging specialists and respiratory specialists. BATMAN was guided by specialists doing continuous x-rays and ultrasounds.
“This would’ve been impossible without all of the trust that patients gave us,” expressed Couture. Even knowing that it would be the first time we were doing that intervention, the patient always gave us his full trust, so it gave us the energy and the audacity to do it for the first time.”