How do you decide the right time for MitraClip intervention in patients with symptomatic heart failure and severe mitral regurgitation who are on maximally tolerated GDMT?

When evaluating these patients, it is always important to consider a multidisciplinary approach inclusive of general cardiologists, imaging experts for MR quantification, and most importantly, heart failure and electrophysiology colleagues. I ensure that the patient is seen by our HF colleagues to truly ensure maximally tolerated GDMT as this was the criteria required by the COAPT trials. Furthermore, they must undergo strict evaluation for device-based therapies such as if they qualify for CRT. Many patients who are candidate for cardiac resynchronization therapy will improve their EF and MR severity after getting this device implanted. So I often have our EP colleagues formally consult even if their criteria is near the QRS length require...