Background <p>Iatrogenic mitral valve injury following aortic valve or root surgery presents a complex and challenging scenario, necessitating a thorough understanding of anatomical, physio-pathological, and technical considerations. This review aims to describe the reported cases of iatrogenic mitral valve regurgitation following aortic valve surgery.</p> Methods <p>PubMed, ScienceDirect, Directory of Open Access Journals, and Cochrane databases were searched from inception until January 2024 for case reports and case series describing iatrogenic mitral valve regurgitation following aortic valve surgery.</p> Results <p>The literature review found 13 articles describing 15 cases of new onset mitral valve regurgitation after aortic valve surgery. The most common mitral lesion was the anterior mitral leaflet perforation (<i>n</i> = 8 patients), followed by rupture of the chordae tendineae (<i>n</i> = 2) and avulsion of the pericardial patch used in Nick’s procedure (<i>n</i> = 2). In eight cases, the mitral defect was immediately detected at the weaning from cardiopulmonary bypass through transesophageal echocardiography. In the other seven patients, the mitral defect was encountered between 3&#xa0;weeks and 4&#xa0;years from the main aortic valve surgery. For this group of patients, a reintervention was performed in 3 patients, while an Amplatzer occluder was placed in three patients.</p> Conclusion <p>Iatrogenic mitral valve injury following aortic valve surgery requires a multidisciplinary approach encompassing detailed anatomical knowledge, precise technical skills, and ongoing advancements in imaging and surgical techniques. By integrating these aspects, cardiac surgeons can mitigate the risks associated with mitral valve injury and optimize patient outcomes in the context of cardiac valve surgery.</p> Graphical Abstract <p></p>