First-In-Human Clinical Study for Treatment of Severe Mitral Valve INsufficiency With Epygon™ TRanscatheter Mitral VAlve System

Inclusion Criteria:

1. Patients of age ≥ 60 years.
2. Patients with primary or secondary severe symptomatic mitral valve regurgitation.
3. Patients with severe, symptomatic mitral regurgitation and who have been evaluated bya multidisciplinary Heart Team and deemed to be ineligible for conventional valvesurgery and not eligible for transcatheter repair.
4. Patients with a left ventricular ejection fraction ≥ 30%.
5. Patients in NYHA functional classes III to IV.
6. Patients who have clearly accepted participation in this clinical study and who havesigned the informed consent.
7. Patients who are willing to accept and undergo all protocol related requirements.
8. Patients not planning to transfer abroad.

Exclusion Criteria:

• Clinical exclusion criteria (preoperative screening)

1. Patients involved in other clinical assessments for drugs or devices that couldinterfere or alter the study endpoints.
2. Patients with clinical/anatomical conditions unsuitable for a transapical surgicalapproach.
3. Patients who have previously undergone implantation of a transcatheter aortic valveprosthesis.
4. Patients with previous implantation of a mitral heart valve prosthesis.
5. Patients with previous implantation of a mitral annuloplasty ring.
6. Patients needing emergency or life-saving interventions.
7. Patients with a heavily calcified mitral annulus and/or anterior mitral leaflet.
8. Patients with active infection or endocarditis (suspect endocarditis included).
9. Patients with echocardiographic evidence of intracardiac mass or thrombus.
10. Patients which suffered an acute myocardial infarction within 30 days of the intendedtreatment (defined as: Q wave MI, or non-Q wave MI with elevation of CK-MB ≥ 3 timesnormal in the absence of pathological Q waves), if no assay for CK-MB was performed,elevation of CK level to >2 times normal without new Q waves, or elevated Troponinlevel is also considered a non-Q wave MI).
11. Patients with an active peptic ulcer or upper GI bleeding within the prior 30 days.
12. Patients with a documented allergy towards contrast media, and to any compound of theinvestigated medical device.
13. Patients that have neurological disease severely affecting ambulation or day to dayfunctioning.
14. Patients with any stroke within the prior 30 days.
15. Patients with senile dementia, according to the advice from a specialized neurologist.
16. Patients in whom transesophageal echocardiography (TEE) is contraindicated since TEEis used for both preoperative screening and guidance during implant procedure.
17. Patients who is unwilling or deemed by the Investigator to be unwilling to comply withthe requirements of the protocol, or subject with a history of non-compliance.
18. Patients unable to understand and sign the Informed Consent Form in absence of legalrepresentative.
19. Patients with a lack of capacity to consent.
20. Patients unable to read and write.

• Echographic exclusion criteria (preoperative screening)

21. Patients with left ventricular apex aneurysm;
22. Patients with aorto-mitral angle <120°;
23. Patients with a systolic/diastolic mitral valve area assessed as not compatible withthe sizing policy matrix defined by the Sponsor.

• Computerized Tomographic (CT) exclusion criteria (preoperative screening)

24. Patients with ventricular morphology (position of papillary muscles, ventricular wallhypertrophy) unsuitable with the study valve design;
25. Patients with aorto-mitral angle <120°;
26. Patients with a systolic/diastolic mitral valve area assessed as not compatible withthe sizing policy matrix defined by the Sponsor.