Background: Mitral-valve repair can be accomplished with a procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitate jet. Objective: Our study was performed to compare surgical repair and mitral clip repair for severe secondary MR after failure of maximum medical treatment. Patients and methods: We none randomly were sixty patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation, 30 patients underwent percutaneous repair by clip and 30 patients underwent conventional surgery for repair of the mitral valve. The primary composite end point for efficacy was freedom from death, required surgery for mitral valve dysfunction (stenosis or regurgitation), and absence of significant MR (grade 3+ or 4+) at 6 months follow up. Results: At 6 months, the rates of the primary end point for efficacy were 79% in the percutaneous repair group and 60% in the surgery group (P = 0.020). The respective rates of the components of the primary end point were as follows: death, 6.9%versus 25%, required surgery for mitral-valve dysfunction, 6.9% versus 10.7%; and significant MR, 16% versus 33%. Major adverse events occurred in 20% of patients in the percutaneous-repair group and 50% of patients in the surgery group at 30 days (P<0.001). Conclusions: Percutaneous treatment was associated with increased safety, improved left ventricular volumes, clinical improvements in NYHA classes and quality of life.