A Study of Percutaneous Repair of Functional Mitral Regurgitation Using the Ancora Heart, Inc. AccuCinch® Ventricular Repair System - The CINCH-2 Study

Inclusion Criteria:

• Age ≥ 18 years
• Severity of FMR: ≥ Moderate (i.e., 2+)
• Ejection Fraction: ≥ 20% to ≤60%
• Symptom Status: NYHA II-IVa
• Treatment and compliance with optimal guideline directed medical therapy for heartfailure for at least 1 month
• Surgical risk: Subject is eligible for cardiac surgery (specific EuroSCORE (LES orESII), STS, or comorbidities should demonstrate high risk features)
• Completion of all qualifying diagnostic and functional tests and agrees to comply withstudy follow-up schedule

Exclusion Criteria:

• Significant organic mitral valve pathology (e.g. myxomatous degeneration, mitral valveprolapse or flail leaflets)
• Myocardial infarction or any percutaneous cardiovascular intervention, cardiovascularsurgery, or carotid surgery within 30 days
• Prior surgical, transcatheter, or percutaneous mitral valve intervention
• Untreated clinically significant coronary artery disease (CAD) requiringrevasularization
• Hemodynamic instability: Hypotension (systolic pressure <90 mmHg) or requirement forinotropic support or mechanical hemodynamic support
• Any planned cardiac surgery within the next 6 months (including right heartprocedures)
• NYHA class (i.e., non-ambulatory) or ACC/AHA Stage D heart failure
• Fixed pulmonary artery systolic pressure >70 mmHg
• Severe tricuspid regurgitation (per ASE guidelines and graded by the Echo Core Lab)
• Modified Rankin Scale ≥ 4 disability
• Hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis, orany other structural heart disease causing heart failure other than dilatedcardiomyopathy of either ischemic or non-ischemic etiology
• Mitral valve area less than 4.0 cm2
• Anatomical pathology/contraints preventing appropriate access/ implant of theAccuCinch System
• Renal insufficiency (i.e., eGFR of <30ml/min/1.73m2 ; Stage 4 or 5 CKD)
• Moderate or severe aortic valve stenosis or regurgitation or aortic valve prosthesisFluoroscopic or echocardiographic evidence of severe aortic arch calcification, mobileaortic atheroma, intracardiac mass, thrombus or vegetation
• Active bacterial endocarditis
• History of stroke within the prior 3 months
• Subjects in whom anticoagulation or antiplatelet therapy is contraindicated
• Known allergy to nitinol, polyester, or polyethylene
• Any prior true anaphylactic reaction to contrast agents; defined as knownanaphylactoid or other non-anaphylactic allergic reactions to contrast agents thatcannot 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 (CRT or CRTD) or implantablecardioverter defibrillator within 1 month
• Absence of CRT with class I indication criteria for biventricular pacing (left bundlebranch block pattern and QRS duration ≥150 ms)
• On high dose steroids or immunosuppressant therapy
• Female subjects who are pregnant or lactating