Transcatheter mitral valve edge-to-edge repair (MTEER) is a well-established therapy for treatment of severe mitral valve regurgitation (MR) in patients who are poor candidates for mitral valve surgery. This therapy was first approved in the U.S. for degenerative MR based on the results of the EVEREST (Endovascular Valve Edge-to-Edge Repair Study) trials, which showed excellent clinical outcomes and safety in patients with significant MR who were treated with MTEER compared to surgery [ , ]. The benefits of this therapy were further demonstrated in the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) for patients with functional MR [ ]. These benefits include lower rates of death and heart failure hospitalization and improved health status in patients treated with MTEER in addition to guideline-directed medical therapy. However, many MTEER procedures being performed in the United States today fall outside of the confines of the inclusion criteria for such trials. For example, a recent publication reported that 44 % of MTEER procedures performed for functional MR between 2013 and 2020 were for patients who would have been ineligible for inclusion in the COAPT trial [ ]. Accordingly, further data are needed to guide the potential use of MTEER in these other populations.