Mitral regurgitation (MR) represents the most prevalent acquired valvular pathology, estimated to effect over 3.5 million Americans.1 For a select group of high-risk patients, surgical repair of significant MR is not feasible due to substantial medical comorbidities. Though seldom utilized by mitral surgeons, an edge-to-edge technique (Alfieri repair) has been shown to be effective at decreasing MR without significant risk of mitral stenosis (MS).2 The Mitraclip (AbbotVascular, Menlo Park,CA) is a catheter-based device, based on the Alfieri technique, which brings together the anterior and posterior mitral leaflets at the point of maximal regurgitation to improve coaptation and reduce MR. Mitraclip is currently approved for high surgical risk patients with degenerative MR (DMR) and ideally a flail gap of <10 mm and a flail width of <15 mm.3-5 Patients with functional MR (FMR) can be currently treated in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial,3,5-7 which is a randomized trial comparing medical therapy to Mitraclip. Important exclusions for Mitraclip therapy include: 1) a resting effective orifice area <4 cm2, as coaptation results in a slight but potentially significant reduction in valve area,3,5 2) multiple regurgitant jets particularly at the commissures, 3) calcified leaflet edges at site of regurgitation (mitral annular calcification is not an exclusion), and 4) mitral regurgitation due to rheumatic or endocarditis. Additionally, caution should be exercised in utilizing the Mitraclip device in patients with end-stage renal disease, as late calcification and resultant MS have been reported in this patient population.8 The procedure is performed in a hybrid OR or cath lab under general anesthesia utilizing both transesophageal echocardiographic (TEE) and fluoroscopic guidance. The device is placed via percutaneous 24F femoral venous system across the atrial septum. Three-dimensional (3D) echocardiography is extremely helpful in positioning the device for optimal results. Although the goal is minimal residual MR, procedural success is reduction in MR to 1+-2+. If sufficient reduction in MR is not seen following initial clip placement, a second device is often placed as long as there is sufficient valve area. Herein, we describe the technique for transcatheter mitral valve repair using the Mitraclip device for both functional and degenerative MR.