AVJ-514 Japan Trial

Mitral Valve Regurgitation Clinical Trial

Official title:

A Prospective, Multi-Center, Single-Arm Clinical Evaluation of the AVJ-514 System for the Treatment of Symptomatic Chronic Severe Mitral Regurgitation

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02520310
• Other study ID #: AVJ-514
• Status: Completed
• Phase: N/A
• Start date: September 7, 2015
• Est. completion date: May 31, 2021

Study information

• Verified date: June 2021
• Source: Abbott Medical Devices
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The objective of the study is to confirm the reproducibility of the evidence of safety and efficacy of AVJ-514 System technology in Japanese subjects who have been deemed difficult for mitral valve surgery by the local site heart team.

Description:

This study is a prospective, multi-center, single-arm clinical evaluation of the AVJ-514 System for the treatment of symptomatic chronic severe mitral regurgitation (MR) in Japanese subjects deemed difficult for mitral valve surgery by the local site heart team.

Patients will be evaluated at baseline, discharge, 30 days, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years in Japanese Medical Centers.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 30
• Est. completion date: May 31, 2021
• Est. primary completion date: July 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 20 Years and older

Eligibility

Inclusion Criteria:

Subjects must meet all of the following inclusion criteria:

1. Age 20 years or older.

2. Symptomatic moderate-to-severe (3+) or severe MR (4+) chronic Degenerative Mitral Regurgitation (DMR) or Functional Mitral Regurgitation (FMR) determined by assessment of a qualifying transthoracic echocardiogram (TTE) obtained within 90 days and transesophageal echocardiogram (TEE) obtained within180 days prior to subject registration, with MR severity based principally on the TTE study and confirmed by the Echocardiography Core Laboratory (ECL). The ECL may request a TEE.

3. Left Ventricular Ejection Fraction (LVEF) is = 30% within 90 days prior to subject registration, assessed by the site using any one of the following methods: echocardiography, contrast left ventriculography, gated blood pool scan or cardiac magnetic resonance imaging (MRI). Note: The method must provide a quantitative readout (not a visual assessment).

4. New York Heart Association (NYHA) classification is class II, class III, or ambulatory class IV.

5. Subject is deemed difficult for mitral valve surgery due to either Society of Thoracic Surgery (STS) surgical mortality risk for mitral valve replacement of = 8% OR due to the presence of one of the following risk factors:

• Porcelain aorta or mobile ascending aortic atheroma

• Post-radiation mediastinum

• Previous mediastinitis

• Functional MR with LVEF < 40%

• Over 75 years old with LVEF < 40%

• Re-operation with patent grafts

• Two or more prior cardiothoracic surgeries

• Hepatic cirrhosis

• Other surgical risk factor(s)

6. Mitral valve area = 4.0 cm2 assessed by ECL based TTE within 90 days prior to subject registration. The ECL may request a TEE.

7. Left Ventricular End Systolic Dimension (LVESD) is = 60mm assessed by site based on the TTE obtained within 90 days prior to subject registration.

8. The primary regurgitant jet is non-commissural based on TEE, and in the opinion of the AVJ-514 implanting investigator can successfully be treated by the AVJ-514. If a secondary jet exists, it must be considered clinically insignificant.

9. Transseptal catheterization and femoral vein access is determined to be feasible by the treating physician.

10. The subject or the subject's legal representative has been informed of the nature of the study and agrees to its provisions and has provided written informed consent as approved by the Institutional Review Board of the respective clinical site.

Exclusion Criteria:

Subjects must not meet any of the following exclusion criteria:

1. LVEF is < 30%

2. Leaflet anatomy which may preclude AVJ-514 implantation, proper positioning on the leaflets or sufficient reduction in MR by the AVJ-514 based. This evaluation is based on TEE evaluation of the mitral valve within 180 days prior to subject registration and includes:

• Insufficient mobile leaflet available for grasping with the AVJ-514 device

• Lack of both primary and secondary chordal support in the grasping area

• Evidence of significant calcification in the grasping area

• Presence of a significant cleft in the grasping area

3. Life expectancy < 1 year due to associated non-cardiac co-morbid conditions

4. Need for emergent or urgent surgery for any reason

5. Prior open heart mitral valve leaflet surgery or any currently implanted prosthetic mitral valve or any prior transcatheter mitral valve procedure.

6. Echocardiographic evidence of intracardiac mass, thrombus or vegetation.

7. Active endocarditis or active rheumatic heart disease or leaflets degenerated from rheumatic disease (i.e. noncompliant, perforated).

8. Untreated clinically significant coronary artery disease requiring revascularization or significant myocardial ischemia or evidence of an acute myocardial infarction in the prior 90 days of registration.

9. Cerebrovascular accident within 180 days prior to registration

10. Severe symptomatic carotid stenosis (> 70% by ultrasound)

11. Any cardiac surgery within 180 days prior to registration

12. Percutaneous coronary intervention (PCI) within the last 30 days prior to registration

13. Implant of Cardiac Resynchronization Therapy (CRT), Cardiac Resynchronization Therapy with Cardioverter Defibrillator (CRT-D) pacemaker or Implantable Cardioverter Defibrillator (ICD)within the last 30 days prior to registration.

14. Transcatheter aortic valve replacement (TAVR) within the last 30 days prior to registration.

15. Severe tricuspid regurgitation or aortic valve disease requiring surgical treatment.

16. In the judgment of the Investigator, the femoral vein cannot accommodate a 24 F catheter or presence of ipsilateral deep vein thrombosis (DVT).

17. Hemodynamic instability defined as systolic pressure < 90 mmHg without afterload reduction drug or cardiogenic shock or intra-aortic balloon pump.

18. History of bleeding diathesis or coagulopathy or subject will refuse blood transfusions.

19. Active infections requiring current antibiotic therapy (if temporary illness, patients may enroll at least 14 days after discontinuation of antibiotics). Patients must be free from infection prior to treatment. Any required dental work should be completed a minimum of 21 days prior to treatment.

20. Intravenous drug abuse or suspected inability to adhere to follow-up.

21. Patients in whom TEE is contraindicated.

22. A known hypersensitivity or contraindication to study or procedure medications which cannot be adequately managed medically.

23. In the judgment of the Investigator, subjects in whom the presence of a permanent pacemaker or pacing leads would interfere with placement of the test device or the placement of the test device would disrupt the leads.

24. Subject intends to participate in any other investigational or invasive clinical study within a period of 1 year following the AVJ-514 procedure.

25. Currently participating in an investigational drug or another device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints. (Note: Trials requiring extended follow-up for products that were investigational, but have since become commercially available, are not considered investigational trials).

26. In the opinion of the investigator or designee, subject is unable to comply with the requirements of the study protocol or is unsuitable for the study for any reason.

27. In the opinion of the anesthesiologist, general anesthesia is contraindicated.

28. Pregnant or planning pregnancy within next 1 year.

Related Conditions & MeSH terms

• Functional Mitral Regurgitation
• Mitral Insufficiency
• Mitral Stenosis With Insufficiency
• Mitral Valve Incompetence
• Mitral Valve Insufficiency
• Mitral Valve Regurgitation
• Mitral Valve Stenosis

Intervention

Device:
• AVJ-514
Patients receiving AVJ-514 device

Locations

Country	Name	City	State
Japan	Shonan Kamakura General Hospital	Kanagawa
Japan	Sendai Kosei Hospital	Miyagi
Japan	National Cerebral and Cardiovascular Center	Osaka
Japan	Keio University Hospital	Tokyo
Japan	Sakakibara Heart Institute	Tokyo
Japan	Tokyo Women's Medical University Hospital	Tokyo

Sponsors (1)

Lead Sponsor	Collaborator
Abbott Medical Devices

Country where clinical trial is conducted

Japan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants With Acute Procedure Success (APS)	APS is defined as successful implantation of the AVJ-514 device(s) with resulting MR severity of 2+ or less as determined by the Echocardiographic Core Laboratory (ECL) assessment of a discharge echocardiogram. Subjects who die or who undergo mitral valve surgery before discharge are an APS failure.	On day 0 (the day of procedure)
Secondary	Percentage of Participants With Major Adverse Events (MAE) at 30 Days	MAE is a composite of death, stroke, myocardial infarction (MI), renal failure, and non-elective cardiovascular surgery for device or procedure related adverse events occurring after the femoral vein puncture for transseptal access. This outcome measure calculates the percentage of participants with MAE at 30 days (= total subjects with MAE/total subjects enrolled).	30 days
Secondary	Percentage of Participants With MAE at 1 Year	MAE is a composite of death, stroke, myocardial infarction (MI), renal failure, and non-elective cardiovascular surgery for device or procedure related adverse events occurring after the femoral vein puncture for transseptal access. This outcome measure calculates the percentage of participants with MAE at 30 days (= total subjects with MAE/total subjects enrolled).	1 year
Secondary	Number of Participants With MAE Occurring After the Femoral Vein Puncture for Transseptal Access	MAE listed below will be adjudicated by the Clinical Events Committee at 30 days: Death; Stroke; Myocardial infarction; Renal failure; Non-elective cardiovascular surgery for device or procedure related adverse events	30 days
Secondary	Number of Participants With Mitral Valve Stenosis Requiring Surgery	Defined as a mitral valve orifice of less than 1.5 cm^2 as measured by the Echocardiography Core Laboratory.	1 year
Secondary	Number of Participants With Mitral Valve Stenosis Not Requiring Surgery	Defined as a mitral valve orifice of less than 1.5 cm^2 as measured by the Echocardiography Core Laboratory.	1 year
Secondary	Number of Participants With Single Leaflet Device Attachment (SLDA) Requiring Surgery	SLDA is defined as attachment of one mitral valve leaflet to the AVJ-514 device.	1 year
Secondary	Number of Participants With Single Leaflet Device Attachment (SLDA) Not Requiring Surgery	SLDA is defined as attachment of one mitral valve leaflet to the AVJ-514 device.	1 year
Secondary	Number of Participants With Iatrogenic Atrial Septal Defect	Defined as defect ('hole') in the septum between the left and right atria; considered clinically significant if it requires percutaneous or surgical intervention.	30 days
Secondary	Percentage of Participants With Device Implant Rate	Defined as the rate of successful delivery and deployment of one or more AVJ-514 device with echocardiographic evidence of leaflet approximation and retrieval of the delivery catheter.	On the day of procedure
Secondary	Device Procedure Time	Defined as the time elapsed from the start of the transseptal procedure to the time the Steerable Guide Catheter is removed.	On the day of procedure
Secondary	Total Procedure Time	Defined as the time elapsed from the first of any of the following: intravascular catheter placement, anesthesia or sedation, or transesophageal echocardiogram (TEE), to the removal of the last catheter and TEE.	On the day of procedure
Secondary	Device Time	Defined as the time the Steerable Guide Catheter is placed in the intra-atrial septum until the time the AVJ-514 Delivery System (CDS) is retracted into the Steerable Guide Catheter.	On the day of procedure
Secondary	Fluoroscopy Duration	Defined as the duration of exposure to fluoroscopy during the AVJ-514 procedure.	On the day of procedure
Secondary	Length of Stay in Intensive Care Unit (ICU)/Critical Care Unit (CCU)/Post-Anesthesia Care Unit (PACU) (ICU/CCU/PACU)	Length of stay in ICU/CCU/PACU is cumulative hours of Hospital stay in (PACU/CCU/ICU)	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Length of Hospital Stay Excluding Rehabilitation Stay	Length of hospital stay excluding rehabilitation stay = Length of hospital stay (Date of Discharge - Date of Admission)	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Length of Rehabilitation Stay	Cumulative days of rehabilitation stay during hospitalization.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Percentage of Participants With Discharge Status	Location to which subject was discharged (home or another facility).	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Length of Stay (Not at Baseline Facility)	If subject discharged to another facility (different from baseline facility), length of stay at facility to which subject was discharged. Length of Stay (not at baseline facility) = Sum for all eligible log lines which had been entered in Electronic Data Capture (EDC) for ICU/CCU/PACU and rehabilitation.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Number of Participants With Mitral Regurgitation (MR) Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Number of Participants With MR Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Number of Participants With MR Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	30 days
Secondary	Number of Participants With MR Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	6 months
Secondary	Number of Participants With MR Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	1 year
Secondary	MR Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	24 months
Secondary	MR Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	3 years
Secondary	MR Severity Grade	Mitral regurgitation severity is determined based on the American Society of Echocardiography (ASE) Recommendations for Evaluation of The Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. MR severity grade was assessed by the core lab using the transthoracic echocardiogram (TTE) at baseline, discharge and subsequent follow-up visits. The severity of MR is determined by the amount of blood being pushed back into the left atrium when it should be circulating through the left ventricle with each heart beat. MR severity is typically classified as mild (grade 1+), moderate (grade 2+), moderate to severe (grade 3+) or severe (grade 4+).	4 years
Secondary	MR Severity Grade		5 years
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the Echocardiographic Core Laboratory (ECL). In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the Echocardiographic Core Laboratory (ECL). In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the Echocardiographic Core Laboratory (ECL). In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	30 days
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the Echocardiographic Core Laboratory (ECL). In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	6 months
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the Echocardiographic Core Laboratory (ECL). In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	1 year
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the site. In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	24 months
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the site. In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	3 years
Secondary	Regurgitant Volume (RV)	Regurgitant volume as determined by the site. In the presence of regurgitation of one valve, without any intracardiac shunt, the flow through the affected valve is larger than through other competent valves. The difference between the two represents the regurgitant volume.	4 years
Secondary	Regurgitant Volume (RV)		5 years
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the Echocardiographic Core Laboratory (ECL). Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the Echocardiographic Core Laboratory (ECL). Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the Echocardiographic Core Laboratory (ECL). Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	30 days
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the Echocardiographic Core Laboratory (ECL). Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	6 months
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the Echocardiographic Core Laboratory (ECL). Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	1 year
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-diastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-diastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-diastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	30 days
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular enddiastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	6 months
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-diastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	1 year
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the site. Left Ventricular enddiastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	24 months
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the site. Left Ventricular enddiastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	3 years
Secondary	Left Ventricular End Diastolic Volume (LVEDV)	Left Ventricular End Diastolic Volume (LVEDV) as measured by the site. Left Ventricular enddiastolic volume (LVEDV) measured using 2-dimensional echocardiography. The endocardium is traced at end-diastole (frame before mitral valve closure or maximum cavity dimension) in the 2- and 4-chamber views to calculate volumes.	4 years
Secondary	Left Ventricular End Diastolic Volume (LVEDV)		5 years
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	30 days
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	6 months
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the Echocardiography Core Laboratory (ECL). Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	1 year
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the site. Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	24 months
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the site. Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	3 years
Secondary	Left Ventricular End Systolic Volume (LVESV)	Left Ventricular End Systolic Volume (LVESV) as measured by the site. Left Ventricular end-systolic volume (LVESV) measured using 2-dimensional echocardiography. The endocardium is traced at end-systole (frame prior to mitral valve opening or the minimum cavity area) in the 2- and 4-chamber views to calculate volumes.	4 years
Secondary	Left Ventricular End Systolic Volume (LVESV)		5 years
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the Echocardiography Core Laboratory (ECL).	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the Echocardiography Core Laboratory (ECL).	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the Echocardiography Core Laboratory (ECL).	30 days
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the Echocardiography Core Laboratory (ECL).	6 months
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the Echocardiography Core Laboratory (ECL).	1 year
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the site.	24 months
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the site.	3 years
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)	Left Ventricular End Diastolic Dimension (LVEDD) as measured by the site	4 years
Secondary	Left Ventricular End Diastolic Dimension (LVEDD)		5 years
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the ECL.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the ECL.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the ECL.	30 days
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the ECL.	6 months
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the ECL.	1 year
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the site.	24 months
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the site.	3 years
Secondary	Left Ventricular End Systolic Dimension (LVESD)	Left Ventricular End Systolic Dimension (LVESD) as measured by the site.	4 years
Secondary	Left Ventricular End Systolic Dimension (LVESD)		5 years
Secondary	Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF) as measured by the ECL.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF) as measured by the ECL.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF) as measured by the ECL.	30 days
Secondary	Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF) as measured by the ECL.	6 months
Secondary	Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF) as measured by the ECL.	1 year
Secondary	Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF) as measured by the site.	24 months
Secondary	Left Ventricular Ejection Fraction (LVEF)	Left Ventricular Ejection Fraction (LVEF) as measured by the site.	3 years
Secondary	Left Ventricular Ejection Fraction (LVEF)		4 years
Secondary	Left Ventricular Ejection Fraction (LVEF)		5 years
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	30 days
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	6 months
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	1 year
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	24 months
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	3 years
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	4 years
Secondary	Pulmonary Artery Systolic Pressure (PASP)	Pulmonary Artery Systolic Pressure (PASP) is presented in place of Right Ventricular Systolic Pressure (RVSP). PASP is equal to RVSP in the absence of pulmonic stenosis.	5 years
Secondary	Mitral Valve Area (MVA)	It is the orifice area of the mitral valve.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Mitral Valve Area (MVA)	It is the orifice area of the mitral valve.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Mitral Valve Area (MVA)	It is the orifice area of the mitral valve.	30 days
Secondary	Mitral Valve Area(MVA)	It is the orifice area of the mitral valve.	6 months
Secondary	Mitral Valve Area(MVA)	It is the orifice area of the mitral valve.	1 year
Secondary	Mitral Valve Area (MVA)	It is the orifice area of the Mitral Valve	24 months
Secondary	Mitral Valve Area (MVA)	It is the orifice area of the Mitral Valve.	3 years
Secondary	Mitral Valve Area (MVA)	It is the orifice area of the Mitral Valve.	4 years
Secondary	Mitral Valve Area (MVA)		5 years
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the Echocardiography Core Laboratory (ECL).	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the Echocardiography Core Laboratory (ECL).	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the Echocardiography Core Laboratory (ECL).	30 days
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the Echocardiography Core Laboratory (ECL).	6 months
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the Echocardiography Core Laboratory (ECL).	1 year
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the site.	24 months
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the site.	3 years
Secondary	Mean Mitral Valve Pressure Gradient (MVG)	Defined as the mean and peak pressure gradients across the mitral valve as measured by the site.	4 years
Secondary	Mean Mitral Valve Pressure Gradient (MVG)		5 years
Secondary	Number of Participants With Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the ECL.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Number of Participants With Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the ECL	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Number of Participants With Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the ECL	30 days
Secondary	Number of Participants With Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the ECL	6 months
Secondary	Number of Participants With Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the ECL	1 year
Secondary	Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the site.	24 months
Secondary	Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the site.	3 years
Secondary	Systolic Anterior Motion of the Mitral Valve (Present or Absent)	Systolic Anterior Motion (SAM) of the mitral valve is measured by the site.	4 years
Secondary	Systolic Anterior Motion of the Mitral Valve (Present or Absent)		5 years
Secondary	Forward Stroke Volume (FSV)	Defined as the volume of blood pumped from the left ventricle per heartbeat.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Forward Stroke Volume (FSV)	Defined as the volume of blood pumped from the left ventricle per heartbeat.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Forward Stroke Volume (FSV)	Defined as the volume of blood pumped from the left ventricle per heartbeat.	30 days
Secondary	Forward Stroke Volume (FSV)	Defined as the volume of blood pumped from the left ventricle per heartbeat.	6 months
Secondary	Forward Stroke Volume (FSV)	Defined as the volume of blood pumped from the left ventricle per heartbeat.	1 year
Secondary	Forward Stroke Volume (FSV)		24 months
Secondary	Forward Stroke Volume (FSV)		3 years
Secondary	Forward Stroke Volume (FSV)		4 years
Secondary	Forward Stroke Volume (FSV)		5 years
Secondary	Cardiac Output (CO)	Cardiac output as measured by the Echocardiographic Core Laboratory (ECL). Cardiac output is the product of forward stroke volume and heart rate.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Cardiac Output (CO)	Cardiac output as measured by the Echocardiographic Core Laboratory (ECL). Cardiac output is the product of forward stroke volume and heart rate.	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Cardiac Output (CO)	Cardiac output as measured by the Echocardiographic Core Laboratory (ECL). Cardiac output is the product of forward stroke volume and heart rate.	30 days
Secondary	Cardiac Output (CO)	Cardiac output as measured by the Echocardiographic Core Laboratory (ECL). Cardiac output is the product of forward stroke volume and heart rate.	6 months
Secondary	Cardiac Output (CO)	Cardiac output as measured by the Echocardiographic Core Laboratory (ECL). Cardiac output is the product of forward stroke volume and heart rate.	1 year
Secondary	Cardiac Output (CO)	Cardiac output as measured by the site. Cardiac output is the product of forward stroke volume and heart rate.	24 months
Secondary	Cardiac Output (CO)	Cardiac output as measured by the site. Cardiac output is the product of forward stroke volume and heart rate.	3 years
Secondary	Cardiac Output (CO)	Cardiac output as measured by the site. Cardiac output is the product of forward stroke volume and heart rate.	4 years
Secondary	Cardiac Output (CO)		5 years
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the Echocardiographic Core Laboratory (ECL).	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the Echocardiographic Core Laboratory (ECL).	At Discharge (= 14.4 ± 8.5 days post index procedure)
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the Echocardiographic Core Laboratory (ECL).	30 days
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the Echocardiographic Core Laboratory (ECL).	6 months
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the Echocardiographic Core Laboratory (ECL).	1 year
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the site.	24 months
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the site.	3 years
Secondary	Cardiac Index (CI)	Cardiac index is defined as cardiac output divided by body surface area. Cardiac Index was measured by the site.	4 years
Secondary	Cardiac Index (CI)		5 years
Secondary	Number of Participants With All-cause Mortality		1 year
Secondary	All-cause Mortality		24 months
Secondary	All-cause Mortality		3 years
Secondary	All-cause Mortality		4 years
Secondary	All-cause Mortality		5 years
Secondary	Number of Participants With the Primary Safety Composite of MAE at 1 Year	MAE is a composite of death, stroke, MI, renal failure, and non-elective cardiovascular surgery for device or procedure related adverse events occurring after the femoral vein puncture for transseptal access. No of Participants with the MAEs at 12 months. One death and One Renal Failure was reported in two subjects.	12 months
Secondary	Freedom From the Components of the Primary Safety Composite of MAE	MAE is a composite of death, stroke, MI, renal failure, and non-elective cardiovascular surgery for device or procedure related adverse events occurring after the femoral vein puncture for transseptal access.	24 months
Secondary	Freedom From the Components of the Primary Safety Composite of MAE	MAE is a composite of death, stroke, MI, renal failure, and non-elective cardiovascular surgery for device or procedure related adverse events occurring after the femoral vein puncture for transseptal access.	3 years
Secondary	Freedom From the Components of the Primary Safety Composite of MAE	MAE is a composite of death, stroke, MI, renal failure, and non-elective cardiovascular surgery for device or procedure related adverse events occurring after the femoral vein puncture for transseptal access.	4 years
Secondary	Freedom From the Components of the Primary Safety Composite of MAE	MAE is a composite of death, stroke, MI, renal failure, and non-elective cardiovascular surgery for device or procedure related adverse events occurring after the femoral vein puncture for transseptal access.	5 years
Secondary	Number of Patients With New York Heart Association (NYHA) Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Number of Participants With NYHA Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	30 days
Secondary	Number of Participants With NYHA Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	6 months
Secondary	Number of Participants With NYHA Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	1 year
Secondary	NYHA Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	24 months
Secondary	NYHA Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	3 years
Secondary	NYHA Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	4 years
Secondary	NYHA Functional Class	Class I: Patients with cardiac disease but without resulting limitations of physical activity. Class II: Patients with cardiac disease resulting in slight limitation of physical activity. Patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Patients with cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation dyspnea, or anginal pain. Class IV: Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.	5 years
Secondary	Kansas City Cardiomyopathy Questionnaire Quality of Life (KCCQ QoL) Scores	KCCQ is a self-administered questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. This questionnaire is a reliable and responsive health status measure used in various cardiovascular research studies. A minimum mean group difference in KCCQ score of =5 is considered to be clinically significant. Each question responses are coded sequentially (1, 2, 3, 4, 5 and 6) from worst to best status. Scores are generated by adding points for all questions and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	KCCQ QoL Scores	KCCQ is a self-administered questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. This questionnaire is a reliable and responsive health status measure used in various cardiovascular research studies. A minimum mean group difference in KCCQ score of =5 is considered to be clinically significant. Each question responses are coded sequentially (1, 2, 3, 4, 5 and 6) from worst to best status. Scores are generated by adding points for all questions and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status.	30 days
Secondary	KCCQ QoL Scores	KCCQ is a self-administered questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. This questionnaire is a reliable and responsive health status measure used in various cardiovascular research studies. A minimum mean group difference in KCCQ score of =5 is considered to be clinically significant. Each question responses are coded sequentially (1, 2, 3, 4, 5 and 6) from worst to best status. Scores are generated by adding points for all questions and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status.	6 months
Secondary	KCCQ QoL Scores	KCCQ is a self-administered questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. This questionnaire is a reliable and responsive health status measure used in various cardiovascular research studies. A minimum mean group difference in KCCQ score of =5 is considered to be clinically significant. Each question responses are coded sequentially (1, 2, 3, 4, 5 and 6) from worst to best status. Scores are generated by adding points for all questions and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status.	1 year
Secondary	Change in KCCQ QoL Scores From Baseline to 1 Year	KCCQ is a self-administered questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. This questionnaire is a reliable and responsive health status measure used in various cardiovascular research studies. A minimum mean group difference in KCCQ score of =5 is considered to be clinically significant. Each question responses are coded sequentially (1, 2, 3, 4, 5 and 6) from worst to best status. Scores are generated by adding points for all questions and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status.	Baseline to 1 Year
Secondary	KCCQ QoL Scores	KCCQ is a self-administered questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. This questionnaire is a reliable and responsive health status measure used in various cardiovascular research studies. A minimum mean group difference in KCCQ score of =5 is considered to be clinically significant. Each question responses are coded sequentially (1, 2, 3, 4, 5 and 6) from worst to best status. Scores are generated by adding points for all questions and scaled from 0 to 100, with 0 denoting the worst and 100 the best possible status.	24 months
Secondary	KCCQ QoL Scores	The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.	3 years
Secondary	KCCQ QoL Scores	The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.	4 years
Secondary	KCCQ QoL Scores	The Kansas City Cardiomyopathy Questionnaire is a 23-item, self-administered instrument that quantifies physical function, symptoms (frequency, severity and recent change), social function, self-efficacy and knowledge, and quality of life.	5 years
Secondary	SF-36 QoL Scores	The Short Form(SF) (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.; The physical & mental functions were assessed by the Physical Component Summary (PCS) score & Mental Component Summary (MCS) score. Normal PCS and MCS scores vary depending on the demographics of the population studied. The PCS&MCS norms for 65-75 year old are 44 & 52, respectively while the norms for congestive heart failure (CHF) population are 31 & 46, respectively.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	SF-36 QoL Scores	The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.; The physical & mental functions were assessed by the Physical Component Summary (PCS) score & Mental Component Summary (MCS) score. Normal PCS and MCS scores vary depending on the demographics of the population studied. The PCS&MCS norms for 65-75 year old are 44 & 52, respectively while the norms for CHF population are 31 & 46, respectively.	30 days
Secondary	SF-36 QoL Scores	The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.	6 months
Secondary	SF-36 QoL Scores	The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.	1 year
Secondary	Change in SF-36 QoL Scores From Baseline to 1 Year		From baseline to 1 year
Secondary	SF-36 QoL Scores	The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.	24 months
Secondary	Change in SF-36 QoL Scores From Baseline		At 24 months
Secondary	Number of Participants Undergoing Mitral Valve Surgery		Through 5 years
Secondary	Number of Participants With Additional Mitra Clip Device Intervention		Through 5 years
Secondary	Six Minute Walk Test (6MWT) Distance	The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). It evaluates the global and integrated responses of all the systems involved during exercise, including the pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. It does not provide specific information on the function of each of the different organs and systems involved in exercise or the mechanism of exercise limitation, as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Six Minute Walk Test (6MWT) Distance	The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). It evaluates the global and integrated responses of all the systems involved during exercise, including the pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. It does not provide specific information on the function of each of the different organs and systems involved in exercise or the mechanism of exercise limitation, as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity.	6 months
Secondary	Six Minute Walk Test (6MWT) Distance	The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). It evaluates the global and integrated responses of all the systems involved during exercise, including the pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. It does not provide specific information on the function of each of the different organs and systems involved in exercise or the mechanism of exercise limitation, as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity.	1 year
Secondary	Changes in Six Minute Walk Test (6MWT) Distance From Baseline to 1 Year		Baseline to 1 year
Secondary	Six Minute Walk Test (6MWT) Distance	The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). It evaluates the global and integrated responses of all the systems involved during exercise, including the pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. It does not provide specific information on the function of each of the different organs and systems involved in exercise or the mechanism of exercise limitation, as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity.	24 months
Secondary	Changes in Six Minute Walk Test (6MWT) Distance From Baseline		At 24 months
Secondary	Six Minute Walk Test (6MWT) Distance	The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). It evaluates the global and integrated responses of all the systems involved during exercise, including the pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. It does not provide specific information on the function of each of the different organs and systems involved in exercise or the mechanism of exercise limitation, as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity.	3 years
Secondary	Six Minute Walk Test (6MWT) Distance	The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). It evaluates the global and integrated responses of all the systems involved during exercise, including the pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. It does not provide specific information on the function of each of the different organs and systems involved in exercise or the mechanism of exercise limitation, as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity.	4 years
Secondary	Six Minute Walk Test (6MWT) Distance	The 6MWT is a practical simple test that requires a 100-ft hallway but no exercise equipment or advanced training for technicians. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). It evaluates the global and integrated responses of all the systems involved during exercise, including the pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. It does not provide specific information on the function of each of the different organs and systems involved in exercise or the mechanism of exercise limitation, as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity.	5 years
Secondary	Number of Participants With Mitral Valve Surgery	Surgical access to repair or replace the mitral valve. Measured per occurrence.	30 days
Secondary	Number of Participants With Mitral Valve Surgery	Surgical access to repair or replace the mitral valve. Measured per occurrence.	1 year
Secondary	Number of Participants With Additional AVJ-514 Device Intervention	Number of participants with any additional AVJ-514 procedure after the index procedure. Measured per occurrence.	30 days
Secondary	Number of Participants With Additional AVJ-514 Device Intervention	Number of participants with any additional AVJ-514 procedure after the index procedure. Measured per occurrence.	1 year
Secondary	Number of Hospitalizations and Reason for Hospitalization		1 year post index procedure
Secondary	Number of Hospitalizations		24 months
Secondary	Number of Hospitalizations		3 years
Secondary	Number of Hospitalizations		4 years
Secondary	Number of Hospitalizations		5 years
Secondary	Number of Participants With Mitral Stenosis	Defined as a mitral valve orifice of less than 1.5 cm2 as measured by the Echocardiography Core Laboratory.	1 year
Secondary	Mitral Stenosis	Defined as a mitral valve orifice of less than 1.5 cm2 as measured by the site.	24 months
Secondary	Mitral Stenosis	Defined as a mitral valve orifice of less than 1.5 cm2 as measured by the Echocardiography Core Laboratory.	3 years
Secondary	Mitral Stenosis	Defined as a mitral valve orifice of less than 1.5 cm2 as measured by the Echocardiography Core Laboratory.	4 years
Secondary	Mitral Stenosis	Defined as a mitral valve orifice of less than 1.5 cm2 as measured by the Echocardiography Core Laboratory.	5 years
Secondary	Number of Participants With Clinically Significant Atrial Septal Defect (ASD) That Requires Intervention	Defect ('hole') in the septum between the left and right atria; considered clinically significant if it requires percutaneous or surgical intervention (repair of ASD completed at the time of surgery for other reasons, but not as the primary reason for surgery, is not counted as ASD.)	12 months
Secondary	Number of Participants With Clinically Significant ASD That Requires Intervention	Defect ('hole') in the septum between the left and right atria; considered clinically significant if it requires percutaneous or surgical intervention (repair of ASD completed at the time of surgery for other reasons, but not as the primary reason for surgery, is not counted as ASD.)	24 months
Secondary	Number of Participants With Clinically Significant ASD That Requires Intervention	Defect ('hole') in the septum between the left and right atria; considered clinically significant if it requires percutaneous or surgical intervention (repair of ASD completed at the time of surgery for other reasons, but not as the primary reason for surgery, is not counted as ASD.)	3 years
Secondary	Number of Participants With Clinically Significant ASD That Requires Intervention	Defect ('hole') in the septum between the left and right atria; considered clinically significant if it requires percutaneous or surgical intervention (repair of ASD completed at the time of surgery for other reasons, but not as the primary reason for surgery, is not counted as ASD.)	4 years
Secondary	Number of Participants With Clinically Significant ASD That Requires Intervention	Defect ('hole') in the septum between the left and right atria; considered clinically significant if it requires percutaneous or surgical intervention (repair of ASD completed at the time of surgery for other reasons, but not as the primary reason for surgery, is not counted as ASD.)	5 years
Secondary	Number of Participants With Major Bleeding	Major bleeding is defined as bleeding = Type 3 based on a modified Bleeding Academic Research Consortium (BARC) definition.; Type 3: Type 3a (i) Overt bleeding plus hemoglobin drop of 3 to <5 g/dL* (provided hemoglobin drop is related to bleed) (ii) Any transfusion with overt bleeding; Type 3b (i) Overt bleeding plus hemoglobin drop =5 g/dL* (provided hemoglobin drop is related to bleed) (ii) Cardiac tamponade (iii) Bleeding requiring surgical intervention for control (excluding dental/nasal/skin/hemorrhoid) (iv) Bleeding requiring intravenous vasoactive agents; Type 3c (i) Intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal) (ii) Subcategories confirmed by autopsy or imaging or lumbar puncture (iii) Intraocular bleed compromising vision	30 days
Secondary	Number of Participants With Major Bleeding	Major bleeding is defined as bleeding = Type 3 based on a modified Bleeding Academic Research Consortium (BARC) definition.; Type 3: Type 3a (i) Overt bleeding plus hemoglobin drop of 3 to <5 g/dL* (provided hemoglobin drop is related to bleed) (ii) Any transfusion with overt bleeding; Type 3b (i) Overt bleeding plus hemoglobin drop =5 g/dL* (provided hemoglobin drop is related to bleed) (ii) Cardiac tamponade (iii) Bleeding requiring surgical intervention for control (excluding dental/nasal/skin/hemorrhoid) (iv) Bleeding requiring intravenous vasoactive agents; Type 3c (i) Intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal) (ii) Subcategories confirmed by autopsy or imaging or lumbar puncture (iii) Intraocular bleed compromising vision	1 year
Secondary	Number of Participants With Usage of Concomitant Cardiac Medications	Number of participants with any change in type of medication from baseline to follow-up. Measured in overall counts.	At baseline (Within 14 days prior to the AVJ-514 procedure)
Secondary	Number of Participants With Usage of Concomitant Cardiac Medications	Number of participants with any change in type of medication from baseline to follow-up. Measured in overall counts.	30 days
Secondary	Number of Participants With Usage of Concomitant Cardiac Medications	Number of participants with any change in type of medication from baseline to follow-up. Measured in overall counts.	6 months
Secondary	Number of Participants With Usage of Concomitant Cardiac Medications	Number of participants with any change in type of medication from baseline to follow-up. Measured in overall counts.	1 year
Secondary	Rate of Heart Failure Hospitalizations in the 1 Year Post-AVJ-514 Procedure Compared to the 1 Year Prior		1 Year Pre and Post Index Procedure
Secondary	Number of Participants With Device Embolization Requiring Surgery	Device embolization is defined as detachment of the deployed AVJ-514 device from both mitral leaflets.	1 year
Secondary	Number of Participants With Device Embolization Not Requiring Surgery	Device embolization is defined as detachment of the deployed AVJ-514 device from both mitral leaflets.	1 year
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the site. Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	2 year
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the site. Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	3 year
Secondary	Regurgitant Fraction (RF)	Regurgitant fraction as determined by the site. Regurgitant fraction is defined as the regurgitant volume divided by the forward stroke volume through the regurgitant valve.	4 year