The field of cardiac surgery has drastically changed over the course of half a century. With the implementation of advanced catheter-based techniques, less invasive surgical methods, and generally a sicker population of patients, came a necessary collaboration between disciplines. We have seen this in the treatment of ischemic heart disease and now aortic valve disease. Mitral valve surgery presents a unique population of patients that are both complex and heterogeneous in their pathology. The pathophysiology of these patients may be primarily valvular in origin or secondary to ventricular failure (i.e. functional). In order to determine the safest, most efficacious, and most durable treatment, it is necessary to have a heart team dedicated to the practice. Expertise from cardiologist, interventionalist, advanced anesthesiologist and additional fields become increasingly necessary. The care for this patient population only begins with their evaluation before the invention and endures long after. The literature has demonstrated a disparity in knowledge on the pathophysiology as well as optimal treatment for this cohort. Moreover, the creation of a mitral valve heart team will face significant challenges requiring a change in practitioner culture and even referral pattern. Nevertheless, sharing information between disciplines with an ultimate goal of how best to manage this complex disease is in the foreseeable future. Tracking outcomes and benchmarking institutions with mitral valve heart teams will become the norm.