Reduction or Elimination of Mitral Regurgitation With the SATURN TMVR System (CASSINI-US)

Inclusion Criteria

• Age 18 years or older.
• Symptomatic, moderate to severe or severe, functional or mixed, mitral regurgitation (≥ Grade 3+).
• NYHA functional Class ≥ II. If Class IV, patient must be ambulatory.
• Ability to tolerate oral anticoagulation.
• Ability to qualify for bailout surgery (which may include open heart surgery).
• High risk for open-heart mitral valve surgery due to age, co-morbidities or frailty, as determined by the Heart Team.
• Willing and able to complete study-related assessments and questionnaires.

Exclusion Criteria

• Purely degenerative (organic/primary) (i.e. intrinsic valve lesions) mitral regurgitation.
• Excessive frailty or comorbid conditions that preclude the anticipated benefit of the mitral valve replacement.
• Life expectancy \<1 yr. due to noncardiac conditions.
• Endocarditis in the 3 months prior to procedure date.
• Current admission with acute heart failure exacerbation.
• Dependency on inotropic agents or mechanical circulatory support.
• Untreated clinically significant CAD.
• Active systemic infection.
• Modified Rankin Scale ≥4 disability.
• Chronic renal failure defined as eGFR \< 30 mL/min/m2 or on renal replacement therapy.
• Severe pulmonary arterial hypertension (PAH), defined as PASP > 70mmHg.
• Platelets \< 90,000.
• COPD on home oxygen therapy deemed too high risk for intubation.
• Refuses blood transfusions.
• Documented bleeding or coagulation disorders (hypo- or hyper-coagulable states).
• Severe connective tissue disease under chronic immunosuppressive or cortisone therapy.
• Participating in other investigational studies likely to confound the results or affect the study.
• Unable or does not sign the study informed consent form.
• Patients classified as "vulnerable patients"

Cardiovascular Exclusion Criteria

• Myocardial infarction during prior 30 days.
• Stroke or TIA during prior 90 days.
• Severe extracardiac arteriopathy (safety measure for extra-circulatory support if surgical conversion is needed).
• Prior mitral valve treatment (e.g., valve repair or replacement, MitraClip, etc.), and/or anticipated mitral valve treatment prior to enrollment.
• Prior surgical mechanical valve AVR.
• Prior TAVI. -Need for any planned cardiovascular surgery or intervention (other than for MV disease) within 30 days post-index procedure.
• CRT, CRT-D, IPG or ICD implanted in previous 30 days.
• Cardiogenic shock, hemodynamic instability, Systolic Blood Pressure \<90mmHg, Inotropic dependent or IABP/mechanical circulatory support.

CABG or PCI within previous 30 days.

• Inadequately treated for cardiac condition per applicable standards, such as for coronary artery disease, left ventricular dysfunction, mitral regurgitation, or heart failure, as reviewed by the Patient Screening Committee.
• Prior or planned heart transplantation (UNOS status 1).
• Physical evidence of right-sided CHF:

• Patients with ascites.
• Patients with anasarca (generalized edema / hydropsy).
• Hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis, or other structural heart disease causing heart failure with the exception of dilated ischemic or non-ischemic cardiomyopathy.

Procedural Exclusion Criteria

• Known hypersensitivity or contraindication to procedural or post-procedural medication (e.g., contrast solution, anticoagulation therapy).
• Documented hypersensitivity to nickel or titanium.

Cardiac Imaging Exclusion Criteria (evaluated by Core Labs)

• Contraindications to TEE imaging
• Left ventricular EF ≤ 30% by echocardiogram.
• Severe mitral annular calcification, severe mitral stenosis, valvular vegetation or mass.
• Extensive mitral flail leaflets
• Evidence of new or untreated intracardiac thrombus, mass, or vegetation.
• Severe right ventricular dysfunction.
• Severe tricuspid regurgitation.
• Hemodynamically significant inter-atrial shunt (ASD).
• Severe aortic regurgitation or aortic stenosis.
• Anatomic ineligibility for SATURN Valve or SATURN TS procedure as determined by the Screening Committee.