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1.1 Background

Moderate or severe mitral regurgitation (MR) is the most common valve lesion among adults, with prevalence increasing as a function of age (5, 6). Surgical valve repair yields superior outcomes to replacement in patients with primary MR (7, 8). The evidence base for the treatment of heart failure (HF) patients with secondary MR has recently evolved (9, 10). Due to a combination of the anatomic and functional complexity of the MV and the wide spectrum of pathologies that can affect it, numerous surgical repair and replacement techniques for MR have been developed over the past several decades. Although surgery for secondary MR has been associated with improved functional outcomes and quality of life (QoL) in selected patients (11, 12), operative intervention has not been shown to extend survival in these challenging patients. It follows that several innovative concepts for transcatheter MV …