61-year-old female, Jehovah’s witness, presents with progressive dyspnea NYHA class III despite maximal medical therapy. Past medical history is significant for HFpEF, HTN, HLD, IDDM, CKD stage 3, morbid obesity with BMI 56 kg/m2, and disability ambulating on a walker. TTE and TEE showed severe anterior-directed MR from flail & prolapse P2 with EROA 0.4 mm2, EF less than 55% with mild LV enlargement, moderate LAE, and mild TR. The heart team found the patient at high risk for mitral valve surgery. Now planned for M-TEER via percutaneous femoral venous access with two-clips strategy (MitraClip G4 XTW x I and XT x I).