As the trend toward mitral repair becomes the primary surgical approach for addressing MV pathology, an increasing number of patients may present with failed surgical repairs. Consequently, it is not unexpected that high-risk patients have been evaluated for the mitral ViV procedure instead of undergoing reoperation. When key factors are taken into account during the procedure at expert and well-equipped centers, the success rate appears to be high, with lower mortality and morbidity rates than traditional surgery. Nevertheless, concerns regarding long-term residual gradients, thrombosis, and durability remain.