In clinical practice, guidelines attempt to summarize the status quo of the best available evidence for managing patients with a given disease. Given the rapid expansion of transcatheter mitral valve interventions in inoperable or high-surgical-risk individuals, considerable interest lies in how one should contextualize the emerging transcatheter technologies within the framework of clinical guidelines. Surgery remains the gold-standard approach for treating severe primary mitral regurgitation (MR). However, the dramatic and ongoing evolution of transcatheter mitral valve therapies, coupled with significant long-standing (largely European) experience with the edge-to-edge MitraClip system for both primary and secondary severe MR, has allowed a percutaneous approach to find its place in the treatment armamentarium of high-risk MR patients. Further trials are needed to evaluate the efficacy of transcatheter treatment approaches for severe MR, as well as the use of small footprint devices on lower-surgical-risk patients with secondary MR of moderate severity.