From Mitral Valve Surgeon to Mitral Valve Specialist: Redefining Expertise in Contemporary Mitral Care

The rapid expansion of transcatheter therapies is reshaping the management of mitral valve (MV) disease and the role of cardiac surgery. Surgery remains particularly valuable when it can provide durable repair, comprehensive anatomical correction, and treatment of concomitant cardiac disease, but these advantages must be balanced against procedural burden and individualized risk. As therapeutic options diversify, the surgeon’s role must extend beyond technical performance to disease-specific judgment across surgical and transcatheter strategies, including their implications for future intervention. We propose the concept of the contemporary MV specialist and a corresponding specialized-center model in which reconstructive expertise, multimodality assessment, multidisciplinary decision-making, and longitudinal outcome evaluation are integrated to support individualized treatment. The future relevance of MV surgery will therefore depend not on competition with transcatheter therapies but on delivering durable surgical value within an increasingly comprehensive and patient-centered treatment framework.