Feasibility of the AccuCinch® System for Left Ventricular Reshaping of the Mitral Apparatus to Reduce Functional Mitral Regurgitation and Improve Left Ventricular Function

Inclusion criteria

• Age > 18 years
• Subjects with severe symptomatic functional mitral regurgitation of ≥ 3+ secondary to left ventricular (LV) remodeling and/or annular remodeling, as measured in accordance with the current ASE guidelines and suitable for treatment in accordance with the current AHA/ACC guidelines:

• Left ventricular ejection fraction (LVEF) ≥ 20% and ≤ 40%
• Stable cardiac medical regimen for heart failure for at least 1 month
• Stable NYHA Classification (Class III and above) for at least 1 month
• The subject has been informed of the nature of the study, agrees to its provisions, including the possibility of conversion to surgery, and has provided written informed consent.

Exclusion criteria

Candidates will be excluded from the study if any of the following conditions are present:

• Myocardial infarction within 90 days of the intended treatment with the device
• Prior surgical, transcatheter, or percutaneous mitral valve intervention or mitral valve prosthesis
• Subject has untreated coronary artery disease, which in the opinion of the treating physician and/or heart team, is clinically significant and requires revascularization
• Non-ambulatory NYHA Class IV symptoms of heart failure or subjects in cardiogenic shock or with hemodynamic instability requiring IV inotropic support or mechanical support devices
• Subject has the need for emergent surgery for any reason
• Subjects in whom sufficient quality of echocardiography (TTE and TEE) cannot be obtained
• Echocardiography evidence of primary mitral valve disease causing MR or MS;
• Moderate to severe pulmonary hypertension (PA systolic pressure ≥ 80 mm Hg) as assessed by echocardiography
• Evidence of mitral valve stenosis with an estimated valve area less than 3.5 cm2
• Mitral valve pathology that would prevent adequate function of the GDS Accucinch System
• Subject is on dialysis or estimated GFR < 30mL/min/1.73m2 (Cockcroft-Gault Formula)d d Israni AK, et al. Laboratory Assessment of Kidney Disease, in Brenner and Rector's The Kidney, 9th ed. chapter 25
• Greater than mild mitral annular calcification observed by fluoroscopy
• Presence of aortic valve prosthesis
• Moderate to severe aortic valve stenosis or calcification observed by echocardiography or fluoroscopy
• Severe aortic arch calcification or mobile aortic atheroma observed by echocardiography or fluoroscopy
• Active bacterial endocarditis or active sepsis
• History of bleeding diathesis or coagulopathy
• History of stroke within the prior 6 months
• Subjects in whom anticoagulation is contraindicated
• Any clinical evidence that the investigator feels would place the subject at increased risk with the placement of the device
• Concurrent medical condition with a life expectancy of less than 12 months
• Currently participating in another investigational drug or device study that has not reached its primary endpoint
• Co-morbid conditions that place the subject at an unacceptable surgical risk (e.g. severe chronic obstructive pulmonary disease, hepatic failure, immunological abnormalities, and hematological abnormalities)
• Subject with indication for concomitant surgery such as coronary artery bypass graft (CABG), aortic valve reconstruction or replacement, left ventricular remodeling surgery and congenital repair
• Any cardiac resynchronization therapy within the last 9 months prior to treatment
• Subject on high dose steroids or immunosuppressant therapy
• Current problems with substance abuse (e.g. alcohol, illegal drugs, etc.)
• Female subjects who are pregnant, lactating, or planning pregnancy within next the 36 months. Note: Childbearing age should be instructed to use safe contraception during their participation in this study.
• Subjects who are unable or unwilling to comply with the follow-up schedule and requirements
• Subject has known hypersensitivity to contrast agents that cannot be adequately pre-medicated or has known hypersensitivity to study required medications, to nickel, or to polyurethanes
• Femoral artery lumen diameter of < 5.5 mm, or severe ilio-femoral tortuosity or calcification that would prevent safe placement of the 16Fr introducer sheath