HighFLO Study - HighLife Trans-septal Mitral Valve Replacement (TSMVR) Feasibility Study of the Open Cell CLARITY Valve

Inclusion Criteria:

1. Age ≥ 18 years

2. Moderate-severe or severe mitral regurgitation (≥ 3+)

3. Patient has New York Heart Association (NYHA) Functional Class II, III or ambulatoryIV

4. Patient is under guideline directed medical therapy for at least one month, asreviewed and confirmed by the local multidisciplinary Heart Team

5. Patient is high-risk for open-heart surgery based on the assessment of themultidisciplinary Heart Team using standard scoring systems and consideration ofco-morbidities, frailty, and disability

6. Patient meets the anatomical criteria for HighLife valve

7. Patient is willing to participate in the study and provides signed informed consent

8. Patients with a high risk for LVOTO

Exclusion Criteria:

1. Any stroke/TIA within 30 days

2. Severe symptomatic carotid stenosis (> 70% by non-invasive imaging)

3. Active infections requiring antibiotic therapy

4. Active ulcer or gastro-intestinal bleeding in the past 3 months

5. History of bleeding diathesis, coagulopathy or refusal of future blood transfusion

6. Patients in whom TEE is not feasible

7. Patients who are pregnant or lactating, or plan to get pregnant in the next 12months.

8. Patient is unable to comply with the follow-up schedule and assessments

9. Participation in another clinical investigation at the time of inclusion

10. Patient has known allergies to the device components or contrast medium

11. Patient cannot tolerate anticoagulation or antiplatelet therapy

12. Patients with a life expectancy of less than 12 months due to non-cardiac conditions

13. Patient had permanent pacemaker, or similar device with implantable cardiac leads (i.e. resynchronization therapy) within the last 3 months