Munich Transcatheter Mitral Valve Safety and Effectiveness (MUSE)

Inclusion Criteria: Age ≥ 18 years Moderate or severe mitral regurgitation (> 3+) For Degenerative MR: EROA ≥ 40 mm2 or regurgitant volume ≥ 60ml For Secondary MR: EROA > 30 mm2 or regurgitant volume > 45ml (i.e., MR moderate or severe by ASE criteria) New York Heart Association (NYHA) Functional Class II, III or ambulatory IV Subject is under guideline directed medical therapy for at least one month Subject is high-risk for open-heart surgery based on the assessment of the multidisciplinary Heart Team using standard scoring systems and consideration of co-morbidities, frailty and disability Subject meets the anatomical criteria for Munich TMVR System Patient is willing to participate in the study and provides signed informed consent. Exclusion Criteria: General Conditions Subject who is currently participating in an investigational study, other than this study Subjects allergic to bovine tissue Subjects with uncontrolled hypotension Hemodynamic instability Subject has contrast agent hypersensitivity that cannot be adequately pre-medicated and has an allergy to Nitinol alloys Intolerance to antiplatelet, anticoagulant or thrombolytic medications Bleeding diathesis or hypercoagulable state Active peptic ulcer or active gastrointestinal bleeding Pulmonary artery systolic pressure >70 mmHg Renal insufficiency Need for emergent or urgent surgery for any reason or any planned cardiac surgery within the next 12 months. Subject with hepatic insufficiency Subject has a co-morbid illness that may result in a life expectancy of less than one year Active infection that requires antibiotic therapy Subject is pregnant, breastfeeding or intend to become pregnant within one year, and female subjects in childbearing age NOT using a highly effective method of contraception with a failure rate of less than 1% per year. Comorbidities Prior stroke or TIA within 3 months or Modified Rankin Scale ≥4 disability Acute myocardial infarction within the previous 30 day Any prior heart valve surgery or transcatheter mitral intervention Any percutaneous cardiovascular intervention, cardiovascular surgery, or carotid surgery within 30 days Rheumatic heart disease or endocarditis within the previous 3 months Hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis Severe organic lesion with retracted chordae or congenital malformation and lack of valvular tissue Any other structural heart disease causing heart failure other than dilated cardiomyopathy of either ischemic or non-ischemic etiology. Existence of inferior vena cava filter or atrial septal device (contraindicating femoral access and transseptal catheterization) Untreated clinically significant coronary artery disease requiring revascularization Tricuspid valve disease requiring surgery or severe tricuspid regurgitation Aortic or pulmonic valve disease requiring surgery CRT/ICD implant within 30 days NYHA class IVb UNOS stadium 1 heart transplantation or previous orthotopic heart transplantation Anatomical and Functional Left Ventricular Ejection Fraction (LVEF) <30% LV end diastolic diameter > 70mm Significant abnormalities of the sub-valvular apparatus. Severe mitral annular or leaflets calcification Left atrial or LV thrombus or vegetation Severe right ventricular dysfunction Severe tricuspid or aortic valve disease