Munich Transcatheter Mitral Valve Safety and Effectiveness

Inclusion Criteria: 1. Age ≥ 18 years 2. Moderate or severe mitral regurgitation (\> 3+) 1. For Degenerative MR: EROA ≥ 40 mm2 or regurgitant volume ≥ 60ml 2. For Secondary MR: EROA \> 30 mm2 or regurgitant volume \> 45ml (i.e., MR moderate or severe by ASE criteria) 3. New York Heart Association (NYHA) Functional Class II, III or ambulatory IV 4. Subject is under guideline directed medical therapy for at least one month 5. Subject is high-risk for open-heart surgery based on the assessment of the multidisciplinary Heart Team using standard scoring systems and consideration of co-morbidities, frailty and disability 6. Subject meets the anatomical criteria for Munich TMVR System 7. Patient is willing to participate in the study and provides signed informed consent. Exclusion Criteria: General Conditions 1. Subject who is currently participating in an investigational study, other than this study 2. Subjects allergic to bovine tissue 3. Subjects with uncontrolled hypotension 4. Hemodynamic instability 5. Subject has contrast agent hypersensitivity that cannot be adequately pre-medicated and has an allergy to Nitinol alloys 6. Intolerance to antiplatelet, anticoagulant or thrombolytic medications 7. Bleeding diathesis or hypercoagulable state 8. Active peptic ulcer or active gastrointestinal bleeding 9. Pulmonary artery systolic pressure \>70 mmHg 10. Renal insufficiency 11. Need for emergent or urgent surgery for any reason or any planned cardiac surgery within the next 12 months. 12. Subject with hepatic insufficiency 13. Subject has a co-morbid illness that may result in a life expectancy of less than one year 14. Active infection that requires antibiotic therapy 15. Subject is pregnant, breastfeeding or intend to become pregnant within one year, and female subjects in childbearing age NOT using a highly effective method of contraception with a failure rate of less than 1% per year. Comorbidities 16. Prior stroke or TIA within 3 months or Modified Rankin Scale ≥4 disability 17. Acute myocardial infarction within the previous 30 day 18. Any prior heart valve surgery or transcatheter mitral intervention 19. Any percutaneous cardiovascular intervention, cardiovascular surgery, or carotid surgery within 30 days 20. Rheumatic heart disease or endocarditis within the previous 3 months 21. Hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis 22. Severe organic lesion with retracted chordae or congenital malformation and lack of valvular tissue 23. Any other structural heart disease causing heart failure other than dilated cardiomyopathy of either ischemic or non-ischemic etiology. 24. Existence of inferior vena cava filter or atrial septal device (contraindicating femoral access and transseptal catheterization) 25. Untreated clinically significant coronary artery disease requiring revascularization 26. Tricuspid valve disease requiring surgery or severe tricuspid regurgitation 27. Aortic or pulmonic valve disease requiring surgery 28. CRT/ICD implant within 30 days 29. NYHA class IVb 30. UNOS stadium 1 heart transplantation or previous orthotopic heart transplantation Anatomical and Functional 31. Left Ventricular Ejection Fraction (LVEF) \<30% 32. LV end diastolic diameter \> 70mm 33. Significant abnormalities of the sub-valvular apparatus. 34. Severe mitral annular or leaflets calcification 35. Left atrial or LV thrombus or vegetation 36. Severe right ventricular dysfunction 37. Severe tricuspid or aortic valve disease