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The Prognosis in patients with heart failure and secondary mitral regurgitation is poor. Although surgical mitral valve repair and replacement have not been shown to reduce hospitalizations or death, transcatheter mitral valve repair may improve clinical outcomes. In this multi-center, randomized, controlled, open-labelled trial, 614 patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite maximal medical therapy were randomized to transcatheter mitral-valve repair, plus medical therapy or to medical therapy alone. The primary efficacy end point was all hospitalizations for heart failure within 24 months. The primary safety end point was freedom from device related complications at 12 months. A key pre-specified secondary end point was all-cause mortality within 24 months. The annualized rate of all hospitalizations for heart failure within 24 months was significantly lower in the device group than in the control grou...