Transcatheter Mitral Valve Repair for Inotrope Dependent Cardiogenic Shock

Inclusion Criteria: 1. Participants or substitute decision maker is able and willing to provide written informed consent 2. Age ≥ 18 years 3. SCAI stage C or D cardiogenic shock with persistent inotrope/vasopressor/non-durable mechanical support or unable to wean ventilatory support due to pulmonary edema for 24 hours prior to randomization 4. Greater than or equal to 3+ MR as determined by a study center's transesophageal echocardiogram (TEE) 5. In the opinion of the study center's heart team the participant is anatomically eligible for TMVr with the potential to achieve \<3+ MR Exclusion Criteria: 1. Unwilling or unable to obtain informed consent from the participant or substitute decision maker 2. Revascularization of coronary artery disease performed in the 48 hours prior to randomization 3. If the mechanism of MR is deemed to be degenerative, in the opinion of the heart team the participant is eligible for surgical intervention 4. Prior mitral valve leaflet surgery or implanted mitral valve prosthesis (excluding ring) 5. Echocardiographic evidence of left sided intracardiac mass or thrombus 6. Diagnosis of active infective endocarditis 7. Transesophageal echocardiogram is contraindicated 8. Mitral valve anatomy deemed contraindication to TMVr implantation that cannot be addressed procedurally as determined by the study center's heart team 9. Any aortic valve disease greater than moderate in severity 10. A known hypersensitivity or contraindication to procedure medications which cannot be adequately managed medically 11. Out of hospital cardiac arrest or in-hospital cardiac arrest without documented neurologic recovery 12. Plan for durable mechanical circulatory support implantation prior to TMVr 13. In the opinion of the treating team, there is a significant comorbidity that would limit life expectancy in hospital 14. Pregnant or planning to become pregnant in the next 6 months.