Percutaneous mitral valve repair for patients with mitral regurgitation is emerging as an exciting new area in interventional cardiology. Because of the complex etiologies of mitral regurgitation, multiple technologies are being tested in preclinical and clinical settings to evaluate their efficacy and safety. Direct percutaneous repair of the mitral valve is undergoing Phase II and Phase I trials using the Evalve mitral clip and Edwards mitral suture devices, respectively. Devices placed in the coronary sinus might be applicable for specific patient populations where the mitral annulus and coronary sinus have favorable anatomic relationships. Other devices employ intra-atrial or intra-ventricular approaches to the mitral annulus to move the posterior annulus forward and thereby improve mitral valve coaptation. How many of these new techniques will ultimately be successful for clinical use will depend on the results of ongoing clinical trials.