Edge-to-edge Mitral Valve Repair in ATTR-CM

Inclusion criteria (all must be present) * Proven ATTR-CM * Significant symptomatic MR (3+ or 4+ by independent echocardiographic core laboratory assessment) * Subject has been adequately treated per applicable standards, including for coronary artery disease and heart failure (e.g., diuretics) * New York Heart Association (NYHA) functional class II, III, or ambulatory IV * Local heart team has determined that mitral valve surgery will not be offered as a treatment option, even if the subject is randomized to the control group * Left ventricular ejection fraction ≥20% * Anatomical feasibility for TEER as per discretion of the implanting investigator * Age 18 years or older * Subject or guardian agrees to all provisions of the protocol, including the possibility of randomization to the Control group and returning for all required post-procedure follow-up visits, and has provided written informed consent Exclusion criteria (all must be absent) * AL-associated cardiomyopathy * Aortic valve disease requiring surgery or transcatheter intervention * Severe right ventricular dysfunction * Hemodynamic instability requiring inotropic support or mechanical heart assistance * Leaflet anatomy which may preclude TEER, proper device positioning on the leaflets or sufficient reduction in mitral regurgitation by TEER * Life expectancy \<12 months due to non-cardiac conditions * Prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve, or any prior transcatheter mitral valve procedure * Echocardiographic evidence of intracardiac mass, thrombus or vegetation * Active endocarditis or active rheumatic heart disease or leaflets degenerated from rheumatic disease (i.e., noncompliant, perforated) * Active infections requiring current antibiotic therapy * Transesophageal echocardiography (TEE) is contraindicated or high risk * Pregnant or planning pregnancy within next 12 months * Currently participating in another investigational device study that has not reached its primary endpoint