Comparison of Transcatheter Edge-to-edge Repair Using Echo Only with Echo Combined with X Ray for Mitral Regurgitation (ECHO-CLIP)

Inclusion Criteria: \*Subjects meet either the first or second inclusion criteria in combination with the third and fourth ones were eligible. 1. Symptomatic DMR subjects with MR ≥ 3+ at high surgical risk in terms of STS Predicted Risk of Mortality replacement score ≥ 8 or STS Predicted Risk of Mortality repair score ≥ 6.\* 2. FMR subjects with LVESD ≤ 70 mm and MR ≥ 3+, despite administration of GDMT for 30 days.\* 3. MV anatomy appropriate for TEER procedure. 4. Subjects willing to participate in this study and complete the follow-up on schedule after obtaining informed consent. Exclusion Criteria: 1. Myocardial infarction within 12 weeks prior to randomization. 2. Need for concurrent other cardiac procedures. 3. Any endovascular intervention or surgery within 30 days prior to randomization. 4. LVEF \< 20%. 5. MV orifice area \< 4.0 cm2. 6. Pulmonary artery systolic pressure \> 70 mmHg, as determined by echocardiogram. 7. Severe mitral annular calcification. 8. Unsuitable MV anatomy potentially precluding clip implantation: leaflet calcification or significant leaflet cleft in the grasping zone. 9. Previous MV surgery or current implanted ventricular assist device or current implanted mechanical prosthetic valve. 10. Any intracardiac mass, thrombus, or vegetation, as evidenced by echocardiogram. 11. Active endocarditis or rheumatic heart disease. 12. History of DVT or PE. Abbreviations: DMR, degenerative mitral regurgitation; MR, mitral regurgitation; STS, Society of Thoracic Surgeons; FMR, functional mitral regurgitation; LVESD, left ventricular end-systolic diameter; GDMT, guideline-directed medical therapy; TEER, transcatheter edge-to-edge repair; LVEF, left ventricular ejection fraction; MV, mitral valve; DVT, deep venous thrombosis; PE, pulmonary embolism.