High and Intermediate Risk Degenerative Mitral Regurgitation Treatment: A Trial Comparing MitraClip® to Surgical Therapy

Inclusion Criteria: * Gender: Both, male and female * Minimum Age: 18 Years * Maximum Age: no maximum age * Severe (4+) DMR (degenerative mitral regurgitation), or 3+ DMR * NYHA Functional Class III or IV * Mitral valve anatomy should be suitable for both MitraClip® and Mitral valve surgery (repair or replacement) * Subjects meet the following conditions: Age \>18 and high or intermediate risk patients with an STS calculated mortality (using the repair calculator) \>=3% and \<=10% or as determined by the local Heart Team (which should include a surgeon and a cardiologist), based on the evidence that STS risk calculator may not identify all possible risk factors * patient is operable * Signed by the subject and dated approved informed consent prior to any study related procedure * Available and able to return to study site for post-procedural follow-up examination Exclusion Criteria: * Patient incapable to approve the informed consent or Emergency Cases * functional mitral valve pathology * evolving endocarditis or active endocarditis in the last 3 months * heavily calcified leaflets * subjects in whom transesophageal echocardiography is contraindicated * subjects in whom transseptal catheterisation is contraindicated * presence of any known life threatening (non-cardiac major or progressive disease), non-cardiac disease that will limit the subject's life expectancy to less than one year * currently participating in the study of an investigational drug or device * untreated clinically significant CAD requiring revascularisation * any percutaneous coronary, carotid, endovascular intervention or carotid surgery within 30 days or any coronary or endovascular surgery within 3 months * prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve, or any prior transcatheter mitral valve procedure * concomitant and significant aortic or tricuspid valve pathology * CVA or TIA within 6 months or severe carotid stenosis (\>70% assessed by Ultrasound) * contraindication or known allergy to device's components, aspirin, anti-coagulation therapy or contrast media that cannot be adequately managed with premedication