Jaipur, August 13, 2025 : Just ahead of India’s 78th Independence Day, a groundbreaking cardiac intervention was performed at Rajasthan Hospital, Jaipur, marking India’s first electrosurgical valve-in-valve mitral procedure — popularly dubbed the “Batman Procedure.” This technically complex, minimally invasive transcatheter intervention was successfully done on a 74-year-old woman suffering from a failing mitral bioprosthesis, offering hope to high-risk patients who cannot undergo traditional open-heart surgery.

What is the Batman Procedure?
Dr. Ravinder Singh Rao, Chairman of the RHL Heart Centre and head of the TAVI Program, explains that the “Batman Procedure” is a balloon-assisted electrosurgical intervention targeting complex mitral valve problems. The name comes from the visual of the inflated balloon in the aorta resembling the Bat-Signal, which helps control blood flow during the delicate treatment of a damaged mitral valve leaflet. This advanced procedure combines electrosurgery and transcatheter valve-in-valve implantation techniques to replace or repair valves without opening the chest.

Why is it so complex and rare?
Mitral valve interventions are among the most challenging in cardiac care due to the valve’s anatomy and the risk of obstructing blood flow to the left ventricle. Dr. Rao emphasizes that this procedure is reserved for patients with prior valve surgeries or those deemed too high-risk for open-heart surgery. The success of such interventions demands sophisticated imaging, expert operators, and a coordinated multidisciplinary team. Electrosurgical techniques for mitral valves are still emerging, with limited cases worldwide.

The Jaipur Success Story
The 74-year-old patient had previously undergone dual valve replacement but developed mitral bioprosthesis failure. Due to her age and health risks, a repeat open-heart surgery was deemed too dangerous. The team performed the valve-in-valve implantation via catheter with electrosurgical modification, allowing a faster recovery. The patient walked within days and was discharged shortly after, showcasing the benefits of minimally invasive approaches.

“This case shows that even elderly, high-risk patients can receive transformative cardiac treatment with the right expertise,” said Dr. Rao.

What Patients and Families Should Know
The Batman Procedure is not a routine treatment but reserved for select cases with specific anatomical challenges and surgical risks. It requires advanced cath lab infrastructure and highly trained specialists. Post-procedure recovery tends to be quicker than traditional surgery but demands lifelong follow-up and cardiac care. Currently, only a few centers in India offer this sophisticated procedure.

Significance for India’s Heart Health
Valvular heart disease remains a major but underdiagnosed health issue in India, especially among older adults and women. Mitral valve involvement often leads to complications like pulmonary hypertension and heart failure. Cardiovascular diseases are a leading cause of mortality in India, underscoring the need for advanced treatment options alongside prevention.

Looking Ahead
While the Batman Procedure represents a remarkable leap, it will likely remain a rare last-resort option due to high costs, training requirements, and limited facilities. Broader adoption will depend on ongoing research, outcome tracking, and specialized training. Simultaneously, improving early detection and equitable access to cardiac care must remain priorities.

India’s first Batman Procedure is a beacon of hope for many facing complex heart valve diseases, illustrating how cutting-edge technology can transform patient outcomes.