Background: Moderate-to-severe ischemic mitral regurgitation (IMR) accounts for 10-20% of ischemic heart disease (IHD) cases. Although the widespread recommendations by the guidelines for dealing with it surgically, they don't clearly address mitral valve (MV) repair to be of choice over MV replacement (MVR) due to the numerous contradictory and un-conclusive results reported about both techniques. Objective: This study aimed to evaluate the impact of MVR in treating moderate-to-severe IMR on one-year outcomes [left ventricular (LV) function, mortality, major cardiac problems, cerebrovascular adverse events, functional status, and quality of life]. Patients and methods: This retrospective study included twenty-three patients presented with IHD complicated with moderate-to-severe IMR and operated upon by coronary artery bypass grafting (CABG) and MVR. All relevant data were evaluated in the preoperative, intraoperative, and over one-year postoperative periods. Results: The mean age was 58.22 ± 3.58 years. They were all in Canadian Cardiovascular Society (CCS) grade III. The mean preoperative left ventricular ejection fraction per cent (LVEF %) was 40.75 ± 1.35. Intraoperative mortality was nil. Early (immediate) postoperative mortality was 4.34%. Late mortality was nil. The overall hospital complications rate was 21.73%. The overall one-year survival rate was 95.65% with statistically significant improvement of LVEF% with a mean of 52.86 ± 1.59 (p < 0.001), CCS grade and New York Heart Association (NYHA) class whereas 90.91% were in CCS grade I and NYHA class I while 9.09% in CCS grade II and NYHA class II (p < 0.001). Conclusion: Although conjoint MVR with CABG resembles an aggressive approach for treating moderate-to-severe IMR, its performance is safe and beneficial. Even hazardous in the early postoperative period, it showed lower rates of intraoperative, early and late mortality and morbidities particularly the newly developed postoperative atrial fibrillation (AF) and low cardiac output syndrome. At one-year follow-up period, it resulted in preserving and augmenting the LV systolic function improving significantly the impaired preoperative LVEF% and the functional clinical status of the patients.