Transventricular Off-pump Mitral Valve Repair

Inclusion Criteria:

* Age 21 years or older.
* Presence of severe degenerative mitral regurgitation confirmed by echocardiography.
* Mitral leaflet anatomy suitable for coaptation to allow reduction of mitral regurgitation without undue leaflet tension.
* Ability to provide informed consent and willingness to comply with study procedures and follow-up.

Exclusion Criteria:

* Functional mitral regurgitation.
* Severe mitral annular or leaflet calcification.
* Significant concomitant valvular disease (e.g., severe aortic stenosis or insufficiency, severe tricuspid regurgitation).
* Left ventricular ejection fraction \<30% or severe right ventricular dysfunction.
* Requirement for concomitant cardiac surgery.
* Prior cardiac valve intervention or structural heart procedure (excluding prior PCI).
* Recent major cardiovascular events (e.g., stroke or myocardial infarction within 30 days).
* Hemodynamic instability or cardiogenic shock at the time of enrollment.
* Significant comorbid conditions that increase procedural risk, including advanced liver disease, severe hematologic abnormalities, or active infection.
* Contraindications to study procedures or required medications, including inability to tolerate anticoagulation or transesophageal echocardiography.
* Pregnancy, lactation, or planned pregnancy during the study period.
* Participation in another investigational device or drug study that could interfere with outcomes.
* Life expectancy less than 12 months or any condition that, in the opinion of the investigator, precludes study participation.