Feasibility Study of the Tioga TMVR System

Inclusion Criteria: Age 18 years or older Symptomatic, moderate to severe (3+) or severe (4+) MR NYHA Functional Classification ≥ II Heart team concurs that TMVR is the preferred treatment over surgical intervention or other available treatment options (e.g., TEER) The subject or the subject's legal representative has been informed of the nature of the study, has agreed to return for post-procedure follow-up visits, and has provided informed consent Exclusion Criteria: LVEF < 25% LVEDD > 70 mm Anatomic features (e.g., annular dimensions, neo-LVOT area, transfemoral and transseptal access, MAC) unsuitable for the Tioga TMVR System Severe aortic valve stenosis or regurgitation Severe right ventricular dysfunction or severe tricuspid valve disease Evidence of intracardiac thrombus, vegetation, or mass Prior mitral valve intervention Prior prosthetic heart valve in any position Any percutaneous coronary, carotid, or other endovascular intervention within 30 days prior to enrollment Any carotid surgery within 30 days prior to enrollment Any open cardiac or vascular surgery (other than carotid surgery) within 90 days prior to enrolment Myocardial infarction within 30 days prior to enrollment Cardiac resynchronization therapy (CRT) device implanted within 30 days of enrollment History of endocarditis within 6 months prior to enrollment or evidence of active systemic infection or sepsis. Planned cardiovascular procedure within 30 days of enrolment Cerebrovascular accident (CVA) or transient ischemic attack (TIA) within 30 days of enrollment Active peptic ulcer or active GI bleeding within 90 days of enrollment Cardiogenic shock or hemodynamic instability requiring inotropic support or mechanical heart assistance Pulmonary arterial hypertension with fixed PASP > 70mmHg or PVR > 5WU that cannot be reduced to less than 5WU with vasodilator therapy Severe chronic obstructive pulmonary Disease (COPD) or airways disease requiring continuous home oxygen Renal insufficiency (eGFR <20 mL/min) or ESRD on dialysis Life expectancy < 12 months Subject is on the waiting list for a transplant or has had a prior heart transplant Child class C cirrhosis Blood dycrasias as defined by acute anemia with Hb < 9, platelets < 75K, WBC < 0.5 Female subjects who is breast feeding or pregnant or planning to become pregnant within the study period. Known hypersensitivity or contraindication to procedural, post procedural medication (e.g., contrast solution) or hypersensitivity to nickel or titanium Inability to tolerate anticoagulation or antiplatelet therapies