Background: The presence of ischemic mitral regurgitation(IMR) is associated with adverse outcomes. The significant recurrence of MR, however, is observed frequently even after surgical treatment in clinical practice. The purpose of this study is to evaluate the recurrence rate and to investigate the perioperative predictors to recurrence of MR after the surgery for IMR. Methods: We retrospectively analyzed 106(m:f=61:45) patients who underwent surgical management for IMR. The echocardiographic parameters, such as severity of MR, EF, diastolic LV dimension, systolic LV dimension, LA size, LV sphericity index, mitral valve(MV) tenting area, MV tenting height(TH), tethering distance, MV intraleaflet angle(MVILa), and MV intraleaflet height(MVILh) were measured. The recurrence rate and perioperative predictors of significant MR were analyzed. Results: Two types of surgery were done such as valvuloplasty combined with CABG(group A,N=79,m=44) and LV volume reduction surgery combined with CABG(group B,N=27,m=17) for IMR. No differences were noted between the two groups in age, sex, and underlying disease. The overall recurrence rate of MR was 17%(N=18/106), and 15.2%(N=12) in group A and 22.2%(N=6) in group B, respectively. Follow-up echocardiographic exam was done at 5.4 months after the surgery. There were no differences between two groups in the recurrence rate and the timing of follow-up exam. Independent perioperative predictors to the recurrence of significant MR by multiple logistic regression analysis were the preoperative TH and the postoperative MVILh(p<0.05,respectively). There was also a good positive correlation between the MR grade and MVILh(preop:r=0.76, postop:r=0.74; p<0.001,respectively), and a good negative correlation between the MR grade and MVILa(preop:r= - 0.68, postop:r= -0.63; p<0.001,respectively). Conclusion: The recurrence rate of significant MR after the surgical repair is 17% within 6 months in postoperative periods. Independent perioperative predictors to the recurrence of MR after the surgery are the preoperative TH and the postoperative MVILh. For the better outcome of the IMR management, those two factors should be considered in surgical repair of IMR.