Mitral regurgitation (MR) is the most prevalent valvular disease worldwide, outpacing aortic stenosis by three times in the elderly [ ]. Despite carrying a 50 % 5-year mortality, up to 60.8 % of patients with severe MR remain untreated [ ]. The remarkable success of transcatheter aortic valve replacement (TAVR) has prompted rigorous research and development toward a mitral solution, with implantation of the first transcatheter edge-to-edge repair (TEER) device, MitraClip (Abbott Laboratories, Santa Clara, CA), in 2003. Since then, more than 150,000 devices have been placed worldwide, as clinical trials suggest clinical benefit with TEER in select heart failure patients with functional MR [ , ], and high-risk surgical candidates with degenerative MR [ ]. Nonetheless, there remains a high screen failure rate for transcatheter mitral valve therapies, 13.7 % of which are attributable to anatomic considerations [ ]. Moreover, TEER may not yield optimal reduction in MR grade on account of such complexities [ ]. Transcatheter mitral valve replacement (TMVR) devices have emerged as a potential solution to address the gap in therapeutic options. However, there remain anatomical constraints – in particular, large annular size, mitral annular calcification, and small neoleft ventricular outflow tract (LVOT) – that exclude many patients from clinical trials. Certainly, a TMVR design which could overcome these obstacles would reduce screen failure rates and expand treatment options for several untreated patients with severe MR. It will remain imperative, however, that such a valve would maintain the safety profile and durability on par with competitors.