Feasibility of the AccuCinch® System for Left Ventricular Reshaping of the Mitral Apparatus to Reduce Functional Mitral Regurgitation and Improve Left Ventricular Function

Inclusion Criteria: * Age \> 18 years * Subjects with severe symptomatic functional mitral regurgitation of ≥ 3+ secondary to left ventricular (LV) remodeling and/or annular remodeling, as measured in accordance with the current ASE guidelines and suitable for treatment in accordance with the current AHA/ACC guidelines: * Left ventricular ejection fraction (LVEF) ≥ 20% and ≤ 40% * Stable cardiac medical regimen for heart failure for at least 1 month * Stable NYHA Classification (Class III and above) for at least 1 month * The subject has been informed of the nature of the study, agrees to its provisions, including the possibility of conversion to surgery, and has provided written informed consent. Exclusion Criteria: Candidates will be excluded from the study if any of the following conditions are present: * Myocardial infarction within 90 days of the intended treatment with the device * Prior surgical, transcatheter, or percutaneous mitral valve intervention or mitral valve prosthesis * Subject has untreated coronary artery disease, which in the opinion of the treating physician and/or heart team, is clinically significant and requires revascularization * Non-ambulatory NYHA Class IV symptoms of heart failure or subjects in cardiogenic shock or with hemodynamic instability requiring IV inotropic support or mechanical support devices * Subject has the need for emergent surgery for any reason * Subjects in whom sufficient quality of echocardiography (TTE and TEE) cannot be obtained * Echocardiography evidence of primary mitral valve disease causing MR or MS; * Moderate to severe pulmonary hypertension (PA systolic pressure ≥ 80 mm Hg) as assessed by echocardiography * Evidence of mitral valve stenosis with an estimated valve area less than 3.5 cm2 * Mitral valve pathology that would prevent adequate function of the GDS Accucinch System * Subject is on dialysis or estimated GFR \< 30mL/min/1.73m2 (Cockcroft-Gault Formula)d d Israni AK, et al. Laboratory Assessment of Kidney Disease, in Brenner and Rector's The Kidney, 9th ed. chapter 25 * Greater than mild mitral annular calcification observed by fluoroscopy * Presence of aortic valve prosthesis * Moderate to severe aortic valve stenosis or calcification observed by echocardiography or fluoroscopy * Severe aortic arch calcification or mobile aortic atheroma observed by echocardiography or fluoroscopy * Active bacterial endocarditis or active sepsis * History of bleeding diathesis or coagulopathy * History of stroke within the prior 6 months * Subjects in whom anticoagulation is contraindicated * Any clinical evidence that the investigator feels would place the subject at increased risk with the placement of the device * Concurrent medical condition with a life expectancy of less than 12 months * Currently participating in another investigational drug or device study that has not reached its primary endpoint * Co-morbid conditions that place the subject at an unacceptable surgical risk (e.g. severe chronic obstructive pulmonary disease, hepatic failure, immunological abnormalities, and hematological abnormalities) * Subject with indication for concomitant surgery such as coronary artery bypass graft (CABG), aortic valve reconstruction or replacement, left ventricular remodeling surgery and congenital repair * Any cardiac resynchronization therapy within the last 9 months prior to treatment * Subject on high dose steroids or immunosuppressant therapy * Current problems with substance abuse (e.g. alcohol, illegal drugs, etc.) * Female subjects who are pregnant, lactating, or planning pregnancy within next the 36 months. Note: Childbearing age should be instructed to use safe contraception during their participation in this study. * Subjects who are unable or unwilling to comply with the follow-up schedule and requirements * Subject has known hypersensitivity to contrast agents that cannot be adequately pre-medicated or has known hypersensitivity to study required medications, to nickel, or to polyurethanes * Femoral artery lumen diameter of \< 5.5 mm, or severe ilio-femoral tortuosity or calcification that would prevent safe placement of the 16Fr introducer sheath