Operative correction of chronic ischemic mitral regurgitation (CIMR) is associated with a high-risk approach. The objective of this retrospective study was to evaluate the short- and long-term results of surgical treatment of CIMR.From 1989 to 1997, mitral valve replacement or repair was performed on 46 patients with CIMR. The average age range was 63.7 +/- 6.9; 8 patients were females; 30 patients (65.2%) were in New York Heart Association (NYHA) functional class III or IV; 4 patients (8.6%) were in chronic atrial fibrillation and preoperative myocardial infarction was lower in 23 patients (50%). Preoperative echo-Doppler analysis showed severe mitral insufficiency in 15 patients (32.6%). Preoperative mean pulmonary artery pressure (PAP) was 33.6 +/- 13.6 mmHg, mean ejection fraction (EF) 37.8 +/- 13.5%. Mitral valve replacement was performed in 12 patients (26%). Mitral valve repair was performed in 34 patients (73.9%). Myocardial revascularization was performed in 42 patients (91.3%) (mean graft/patient 2.2 +/- 0.8); aneurysmectomy was performed in 5 patients (10.8%), and in 2 patients (4.3%) tricuspid insufficiency was corrected by performing annuloplasty.The overall operative mortality was 8.6% (4 patients). The operative mortality for repair was 5.8% (2 patients) and for replacement was 16.6% (2 patients). One patient was reoperated three days after first operation due to annuloplasty dehiscence. Postoperative morbidity included low output syndrome in 7 patients (15.2%), bleeding in 2 patients (4.3%), and cerebral embolism in 2 patients (4.3%). The mean length of stay in intensive care was 6.5 +/- 10.5 days. Follow-up (mean 27.6 +/- 3.3 months) was 88% complete and revealed good functional and clinical results: 86.4% of the patients in I-II NYHA class. One patient was reoperated due to mitral insufficiency progression. Two late deaths occurred, one due to acute myocardial infarction and the other to lung cancer.While long-term follow-up is mandatory, our results suggest that: a) surgical treatment of CIMI is feasible with acceptable operative risks; b) mid-term functional and clinical results are favorable; c) the choice of treatment--valve replacement or repair--is still debatable.