Background: Ischemic mitral regurgitation remains the subject of much debate. The choice between therapeutic options is characterized by the trade-off between reduced early operative morbidity and mortality and avoidance of prosthetic valve related complications with repair, versus a better long-term correction of mitral insufficiency with replacement. Materials and Methods: Between 2005 and 2007, 30 patients undergoing CABG for CAD, with concomitant repair or replacement for their ischemic mitral valve regurgitation are included in the study. Patients are followed up for 2 years. Results: 21 patients had CABG + MVRp, 9 patients had CABG + MVR. Early postoperative mortality was 11% for the replacement group, and 5 % for the repair group. 2 years survival was 78% for the replacement group, and 81% for the repair group. Freedom from > 2+ MR was 76% for the repair group, and 100% for the replacement group among survivors. Conclusion: MV repair may be better in low-risk patients with ischemic mitral regurgitation. Mitral valve replacement with intact subvalvular apparatus should be considered in patients with chronic IMR who have multiple comorbidities, complex regurgitant jets, or severe tethering of both mitral valve leaflets.