90-year-old female with HTN, CKD-3, s/p CABG, RHD with s/p bio-prosthetic MVR (31mm bovine tissue valve in 2003) for severe mitral regurgitation and LAA resection now presents with fatigue, exertional dyspnea and pedal edema. EKG showed A-fib with controlled ventricular rate. Recent TTE on 9/19/19 showed moderate to severe bioprosthetic mitral stenosis with mild MR, moderate TR and moderate-severe pulmonary hypertension. TEE on 10/16/19 showed severe prosthetic mitral stenosis (PG/MG 22/11mm Hg, MVA of 1.2cm2), mod-to-severe TR and moderate pulmonary hypertension. CT scan showed MVA of 1.2cm2 with neo-LVOT area of 288 sq. cm and aorto-mitral angle was 1370. Her STS, Euro score and logistic Euro score were 15.1, 14.7 and 31.4 respectively. Heart Team evaluation found her to be extreme risk for redo MVR due to associated medical comorbidities. Now planned for TF-TMVR via right percutaneous femoral venous access using a 29 mm SAPIEN-3 valve.