The etiology of mitral valve disease is generally categorized as degenerative, ischemic, rheumatic, or infectious. Globally, rheumatic heart disease (RHD) remains a major cause of mitral valve disease. Mitral valve replacement may be performed for both mitral valve stenosis and mitral valve regurgitation due to structural or functional changes in the mitral valve apparatus. Replacement options include mechanical valves, bioprosthetic valves, and less commonly stentless valves or use of a pulmonary autograft. In general, mechanical valves offer increased durability compared to bioprosthetic valves but at the expense of an increased risk of valve thrombosis requiring long term coagulation. Transcatheter mitral valve replacement is an emerging technology for the management of mitral valve disease.