The study is comparing MitraClip® to Surgical therapy in high and intermediate risk patients, who should be older than 18 years, and shall evaluate safety and efficacy of MitraClip® vs. surgery in high or intermediate risk patients. The patients will be randomised (MitraClip® or Surgery). The Study Follow-Up includes 4 visits after procedure (hospital discharge, 1, 6, 12 months post-procedure).

Two-arm, multi-centre, randomised prospective study comparing MitraClip® to Surgical therapy in high and intermediate risk patients. Patients should be older than 18 years and high and intermediate risk is defined by a score (for MV repair) >= 3% and <= 10% or as determined by the local Heart Team (which should include a surgeon and a cardiologist), based on the evidence that STS risk calculator may not identify all possible risk factors. Patients are selected upon clinical conditions and severity of MR. Anatomical feasibility is assessed by ECHO, according to the IFU (information for use).

The purpose of the trial is to evaluate safety and efficacy of MitraClip® vs. surgery in high and intermediate risk patients with DMR. Study Follow-Up includes the following visits after procedure: Hospital discharge, 1, 6, 12 months post-procedure.

Primary Endpoints are the 30-day safety superiority (ITT analysis) and the 12-month efficacy non-inferiority (ITT analysis) of the MitraClip®. The overall rate of Serious Adverse Events (SAEs) and Serious Adverse Device Events (SADEs) until 12 months and the MR Severity reduction at 6 and 12 month in the MitraClip® and Surgery groups are Secondary Endpoints

Inclusion Criteria:

• Gender: Both, male and female
• Minimum Age: 18 Years
• Maximum Age: no maximum age
• Severe (4+) DMR (degenerative mitral regurgitation), or 3+ DMR
• NYHA Functional Class III or IV
• Mitral valve anatomy should be suitable for both MitraClip® and Mitral valve surgery (repair or replacement)
• Subjects meet the following conditions:

Age >18 and high or intermediate risk patients with an STS calculated mortality (using the repair calculator) >=3% and <=10% or as determined by the local Heart Team (which should include a surgeon and a cardiologist), based on the evidence that STS risk calculator may not identify all possible risk factors

• patient is operable
• Signed by the subject and dated approved informed consent prior to any study related procedure
• Available and able to return to study site for post-procedural follow-up examination

Exclusion Criteria:

• Patient incapable to approve the informed consent or Emergency Cases
• functional mitral valve pathology
• evolving endocarditis or active endocarditis in the last 3 months
• heavily calcified leaflets
• subjects in whom transesophageal echocardiography is contraindicated
• subjects in whom transseptal catheterisation is contraindicated
• presence of any known life threatening (non-cardiac major or progressive disease), non-cardiac disease that will limit the subject's life expectancy to less than one year
• currently participating in the study of an investigational drug or device
• untreated clinically significant CAD requiring revascularisation
• any percutaneous coronary, carotid, endovascular intervention or carotid surgery within 30 days or any coronary or endovascular surgery within 3 months
• prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve, or any prior transcatheter mitral valve procedure
• concomitant and significant aortic or tricuspid valve pathology
• CVA or TIA within 6 months or severe carotid stenosis (>70% assessed by Ultrasound)
• contraindication or known allergy to device's components, aspirin, anti-coagulation therapy or contrast media that cannot be adequately managed with premedication