Mitral annular calcification (MAC) poses a persistent diagnostic and management challenge in both the surgical and transcatheter landscape. A recent analysis demonstrated that the presence of MAC alone, regardless of severity, was independently associated with increased operative mortality and adverse postoperative outcomes after surgical mitral valve replacement. 1 Parallel findings have been reported for transcatheter mitral valve replacement (TMVR) and severe MAC. 2 In this regard, the role of TMVR in MAC is still debated, given the worse mortality and widespread concerns regarding left ventricular outflow tract (LVOT) obstruction, paravalvular leak (PVL), embolization, and valve migration. 2,3 These concerns, however, have been an impetus for clinicians to constantly challenge their technical horizons to chisel precisely, through trial and error, the silver bullet in terms of the most optimal TMVR access route.We read with interest the article by Vodstrup and colleagues 4 in this issue of the Journal. They describe a first-in-human case of transatrial TMVR with an inverted 23 Edwards Intuity Elite (Edwards Lifesciences, Irvine, Calif)