Safety and Performance of the AccuCinch® System

Inclusion Criteria: * Study patient is an adult of legal consent age * Severity of FMR: ≥ Moderate * Ejection Fraction: ≥20 to ≤60% * Symptom Status: NYHA II-IVa * Treatment and compliance with optimal guideline directed medical therapy for heart failure for at least 1 month * Surgical risk: Subject is eligible for cardiac surgery Exclusion Criteria: * Patients with significant organic mitral valve pathology (e.g. myxomatous degeneration, mitral valve prolapse or flail leaflets) * Myocardial infarction or any percutaneous cardiovascular intervention, cardiovascular surgery, or carotid surgery within 30 days * Prior surgical, transcatheter, or percutaneous mitral valve intervention * Untreated clinically significant coronary artery disease requiring revascularization * Hemodynamic instability: Hypotension or requirement for inotropic support or mechanical hemodynamic support * Any planned cardiac surgery or interventions within the next 6 months * NYHA class IVb (i.e., non-ambulatory) or ACC/AHA Stage D heart failure * Fixed pulmonary artery systolic pressure \>70 mmHg * Severe tricuspid regurgitation * Modified Rankin Scale ≥ 4 disability * Hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis, or any other structural heart disease causing heart failure other than dilated cardiomyopathy of either ischemic or non-ischemic etiology * Mitral valve area less than 4.0 cm2 * Anatomical pathology/constraints preventing appropriate access/implant of the GDS Accucinch System * Renal insufficiency * Mitral annular calcification * Moderate or severe aortic valve stenosis or regurgitation or aortic valve prosthesis * Fluoroscopic or echocardiographic evidence of severe aortic arch calcification, mobile aortic atheroma, intracardiac mass, thrombus or vegetation * Active bacterial endocarditis * History of stroke within the prior 3 months * Subjects in whom anticoagulation is contraindicated * Anemia * Thrombocytopenia or thrombocytosis * Bleeding disorders or hypercoaguable state * Active peptic ulcer or active gastrointestinal bleeding * Known allergy to nitinol, polyester, or polyethylene * Any prior true anaphylactic reaction to contrast agents; defined as known anaphylactoid or other non-anaphylactic allergic reactions to contrast agents that cannot be adequately pre-medicated prior to the index procedure. * Life expectancy \< 1 year due to non-cardiac conditions * Currently participating in another interventional investigational study * Implant or revision of any rhythm management device or implantable cardioverter defibrillator within the prior month * Absence of CRT with class I indication criteria for biventricular pacing - Subjects on high dose steroids or immunosuppressant therapy * Female subjects who are pregnant, of child bearing potential or lactating