An expandable replacement heart valve prosthesis, configured to transition between a compressed position and an expanded position, the prosthesis having a proximal end and a distal end, the prosthesis comprising: an inner frame comprising: a body comprising: a plurality of circumferentially extendable struts (136a, 136b); and a plurality of longitudinally extending struts; wherein the plurality of circumferentially extendable struts (136a, 136b) and the plurality of longitudinally extending struts form two or more rows of cells (134a, 134b); and a plurality of inner frame anchoring features extending distally from the body; wherein the inner frame is generally hourglass shaped in the expanded position; an outer frame connected to the inner frame and comprising: a plurality of connected first v-shaped struts extending around a circumference of the prosthesis; and a plurality of separate second v-shaped struts, each of the separate second v-shaped struts attached within each of the connected first v-shaped struts; a valve body connected within an interior surface of the inner frame, the valve body comprising a plurality of leaflets arranged to allow flow in a first direction and prevent flow in a second direction opposite the first direction, wherein the leaflets conform to the interior surface of the inner frame when the valve body is in an open position for reducing a formation of thrombi between the plurality of leaflets and the interior surface of the inner frame; and a fabric skirt connected to an inner surface of the outer frame and extending distally beyond a distal end of the outer frame, wherein the fabric skirt is adapted for contacting a mitral annulus and forming a seal. an inner frame comprising: a body comprising: a plurality of circumferentially extendable struts (136a, 136b); and a plurality of longitudinally extending struts; wherein the plurality of circumferentially extendable struts (136a, 136b) and the plurality of longitudinally extending struts form two or more rows of cells (134a, 134b); and a plurality of inner frame anchoring features extending distally from the body; wherein the inner frame is generally hourglass shaped in the expanded position; a body comprising: a plurality of circumferentially extendable struts (136a, 136b); and a plurality of longitudinally extending struts; wherein the plurality of circumferentially extendable struts (136a, 136b) and the plurality of longitudinally extending struts form two or more rows of cells (134a, 134b); and a plurality of circumferentially extendable struts (136a, 136b); and a plurality of longitudinally extending struts; wherein the plurality of circumferentially extendable struts (136a, 136b) and the plurality of longitudinally extending struts form two or more rows of cells (134a, 134b); and a plurality of inner frame anchoring features extending distally from the body; wherein the inner frame is generally hourglass shaped in the expanded position; an outer frame connected to the inner frame and comprising: a plurality of connected first v-shaped struts extending around a circumference of the prosthesis; and a plurality of separate second v-shaped struts, each of the separate second v-shaped struts attached within each of the connected first v-shaped struts; a valve body connected within an interior surface of the inner frame, the valve body comprising a plurality of leaflets arranged to allow flow in a first direction and prevent flow in a second direction opposite the first direction, wherein the leaflets conform to the interior surface of the inner frame when the valve body is in an open position for reducing a formation of thrombi between the plurality of leaflets and the interior surface of the inner frame; and a fabric skirt connected to an inner surface of the outer frame and extending distally beyond a distal end of the outer frame, wherein the fabric skirt is adapted for contacting a mitral annulus and forming a seal. a plurality of connected first v-shaped struts extending around a circumference of the prosthesis; and a plurality of separate second v-shaped struts, each of the separate second v-shaped struts attached within each of the connected first v-shaped struts; a valve body connected within an interior surface of the inner frame, the valve body comprising a plurality of leaflets arranged to allow flow in a first direction and prevent flow in a second direction opposite the first direction, wherein the leaflets conform to the interior surface of the inner frame when the valve body is in an open position for reducing a formation of thrombi between the plurality of leaflets and the interior surface of the inner frame; and a fabric skirt connected to an inner surface of the outer frame and extending distally beyond a distal end of the outer frame, wherein the fabric skirt is adapted for contacting a mitral annulus and forming a seal.