The aim of this study was to report medium-term outcomes of MitraClip implantation in inoperable or high-risk surgical candidates with functional mitral regurgitation (FMR) in our single-centre experience. From October 2008, 109 consecutive patients with FMR underwent MitraClip implantation (mean age 69±9 years; 82% NYHA Class III-IV). Logistic EuroSCORE was 22±16%. Comorbidities included: chronic renal failure (47%), diabetes (22%), COPD (28%). Mean EF was 28±11%; LVEDD was 68±8 mm. Procedural success was 99% and 30-day mortality was 1.8%. At discharge, 87% patients had MR ≤2+. At 12 months, EF was 34.7±10.4% (p=0.002 compared to preoperative value). Actuarial survival at three years was 74.5±7%. Actuarial freedom from MR ≥3+ at 2.5 years was 70±6%. At one-year follow-up, 86% of patients were in NYHA Class I-II. Preoperative pro-BNP level ≥1,600 pg/ml was identified as an independent risk factor of mortality at follow-up. MitraClip therapy for FMR is a valuable alternative to surgery in high-risk patients. Higher preoperative pro-BNP level is a risk factor for mortality at follow-up. Although patients treated in current practice are high-risk, the procedure remains safe and effective in selected patients.