Transcatheter Mitral Valve Replacement: Clinical Challenges, Evolving Indications, and Future Directions.

Mitral regurgitation is a highly prevalent valvular heart disease and, when hemodynamically significant, is associated with adverse outcomes. Despite advances in surgical techniques and catheter-based edge-to-edge repair, a large number of patients remain untreated due to high surgical risk or anatomical limitations. Transcatheter mitral valve replacement (TMVR) has emerged as a promising therapeutic option for these patients. Over the past 15 years, the TMVR field has substantially progressed, with multiple devices advancing to human clinical evaluation. This review aims to provide an overview of the key milestones in TMVR development, patient selection pathways, and the transition from transapical to transseptal delivery. We further summarize the available clinical outcomes across different platforms and discuss remaining knowledge gaps, as well as future directions for this evolving field.