Purpose of Review This review examines the current status of catheter-based repair and replacement for mitral valve disease, with a focus on native primary and secondary mitral valve regurgitation. Recent Findings Transcatheter mitral valve repair with the MitraClip (R), with >40,000 performed procedures worldwide, has significantly advanced the field of transcatheter therapy for mitral valve regurgitation. Transcatheter mitral valve replacement remains in the early stages of development, mainly due to the complex anatomy and physiology of the mitral valve. Early feasibility studies in high-risk patients show promising procedural success, yet the adverse events require further study. Summary Transcatheter therapies for mitral valve disease are the next endeavor for the pioneers of percutaneous structural heart disease interventions. Early results are encouraging but also show that further rigorous study is needed to determine efficacy and safety.