Every year Cleveland Clinic doctors and research scientists assemble a list of the Top 10 Medical Innovations for the coming year. Typically, the main reason a procedure or device makes the list is because of its potential to treat a vast number of patients in safer and more efficient ways. And that is certainly true of a key cardiac development on the 2009 list: percutaneous mitral valve regurgitation repair. At the center of this innovation is a tiny, barbed wishbone-shaped clip that helps hold the leaflets of the mitral valve together, thus restoring healthy blood flow through the leaflets. The clip is delivered to the heart with a catheter that is guided up the femoral vein from the groin. The improved blood flow is almost immediate once the clip is in place. "This will extend therapy to large numbers of patients with heart failure and to those who are not candidates for surgery," says Cleveland Clinic cardiac surgeon Marc Gillinov, MD.