Transventricular Off-pump Mitral Valve Repair for Mitral Regurgitation

Inclusion Criteria: * Age 21 years or older. * Presence of severe degenerative mitral regurgitation confirmed by echocardiography. * Mitral leaflet anatomy suitable for coaptation to allow reduction of mitral regurgitation without undue leaflet tension. * Ability to provide informed consent and willingness to comply with study procedures and follow-up. Exclusion Criteria: * Functional mitral regurgitation. * Severe mitral annular or leaflet calcification. * Significant concomitant valvular disease (e.g., severe aortic stenosis or insufficiency, severe tricuspid regurgitation). * Left ventricular ejection fraction \<30% or severe right ventricular dysfunction. * Requirement for concomitant cardiac surgery. * Prior cardiac valve intervention or structural heart procedure (excluding prior PCI). * Recent major cardiovascular events (e.g., stroke or myocardial infarction within 30 days). * Hemodynamic instability or cardiogenic shock at the time of enrollment. * Significant comorbid conditions that increase procedural risk, including advanced liver disease, severe hematologic abnormalities, or active infection. * Contraindications to study procedures or required medications, including inability to tolerate anticoagulation or transesophageal echocardiography. * Pregnancy, lactation, or planned pregnancy during the study period. * Participation in another investigational device or drug study that could interfere with outcomes. * Life expectancy less than 12 months or any condition that, in the opinion of the investigator, precludes study participation.