MitrAl ValvE RepaIr Clinical Trial (MAVERIC Trial) - United States

Inclusion Criteria: Candidates must meet ALL of the following criteria to be enrolled in the study. * Is ambulatory, able and willing to comply with the study protocol and has provided written informed consent * Age 21-85, inclusive * Trans-septal catheterization is determined to be feasible by the treating physician * NYHA class II-IV heart failure of any etiology * Symptomatic with MR grade ≥ 2+ * LVEF \< 40% * LVEDD \> 50 mm and ≤ 75 mm * No anticipated change in patient's cardiac medication regimen anticipated throughout the course of the study. * In the opinion of the investigator and heart surgery team, the patient is not an appropriate candidate for surgery, and the use of the ARTO System is technically feasible Exclusion Criteria: Candidates will be excluded from enrollment in the study if ANY of the following conditions apply. * In the opinion of the Investigator, the femoral vein and internal jugular vein cannot accommodate a 16 F catheter or the presence of an inferior vena cava (IVC) filter would interfere with advancement of the catheter or ipsilateral DVT is present * Significant structural abnormality of the mitral valve (e.g., flail, prolapse, leaflet calcification) * Significant mitral annular calcification * Hemodynamic instability (systolic pressure \< 90 mmHg without afterload reduction or cardiogenic shock or the need for inotropic support or intra-aortic balloon pump) * Prior mitral valve surgery or valvuloplasty or any currently implanted prosthetic valve or VAD * History of, or active, rheumatic heart disease * History of Atrial Septal Defects (ASD), whether repaired or not * History of previously repaired PFO or PFO associated with clinical symptoms (e.g., cerebral ischemia) within 6 months of the planned investigational procedure * In the opinion of the investigator, an atrial septal aneurysm is present that may interfere with transseptal crossing * Serum creatinine \> 2.5 mg/dL or dialysis dependent * No access to coronary sinus and/or great cardiac vein * Platelet count \< 100 x 103 cells/mm3 * Evidence of active infection (fever with temperature \> 38°C and/or WBC \> 15,000) or endocarditis * Echocardiographic evidence of mass intracardiac thrombus * Patients on prescribed dual antiplatelet therapy (asprin + any P2Y12 inhibitor) that cannot be discontinued. * Percutaneous coronary intervention or surgery anticipated within the 6 month follow up period following the investigational procedure * Biventricular pacing initiated or anticipated within 6 months of the planned investigational procedure * Evidence of an acute myocardial infarction within 12 weeks of the planned investigational procedure * Stroke or TIA within 6 months of the planned investigational procedure * GI bleeding within 6 months of the planned investigational procedure * Intravenous drug abuse or suspected inability to adhere to follow-up * Patients in whom TTE, TEE or ICE is contraindicated * Contraindication to CT scan * A known hypersensitivity or contraindication to study or procedure medications (specifically aspirin, clopidogrel and heparin) that cannot be adequately managed medically * A known allergy or hypersensitivity to nickel * A known need for any other cardiac surgery including surgery for coronary artery disease, atrial fibrillation, pulmonic, aortic or tricuspid valve disease * In the judgment of the Investigator, patients in whom the presence of a permanent pacemaker or pacing leads would interfere with placement of the test device or the placement of the test device would disrupt the leads * Irreversible bleeding disorder, history of bleeding diathesis or coagulopathy or refuses blood transfusion * Evidence of disease or condition expected to compromise survival (\< 1 year) or ability to complete follow-up assessments * Pregnant or breastfeeding women * Currently participating in an investigational drug or another device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints. \[Note: Trials requiring extended follow-up for products that were investigational, but have since become commercially available, are not considered investigational trials\] * Patient not a candidate for emergent surgical bailout in case of need