The first transapical trancatheter mitral valve implantation (TA-TMVI) on the island of Ireland took place on the 27 November 2013 by the RVH Cardiac Surgery team. An elderly patient who had previous cardiac surgery and other significant medical problems was not fit for Mitral Valve Replacement by the conventional open heart approach. The TA-TMVI allowed the surgical team, led by Mr Reuben Jeganathan, to successfully insert an expandable valve through a very small opening in the chest – true key hole surgery- without using cardiopulmonary bypass (the heart-lung machine). This new procedure will allow surgeons, working with their cardiology colleagues, to offer treatments to patients who currently can not be operated on. It should be especially useful in those who have had previous heart surgery.