PURPOSE: Functional mitral regurgitation in ischemic cardiomyopathy carries a poor prognosis, and its surgical management remains problematic and controversial. The purpose of this study is to compare the results of correcting mitral insufficiency on prognosis and course of disease in patients undergoing CABG and MVP for ischemic MR (IMR) versus associated MR (AMR). METHODS: From Apr. 1993 to Dec. 2004, eighty three patients (62.9짹10.1years) with postmyocardial infarction coronary artery disease and mitral regurgitation received coronary artery bypass with mitral valve procedure(valvuloplasty; 74, replacement; 9). Eight cases were needed for various ventricular repairs. The mechanism of MR was leaflet tethering or incomplete closure in 55 cases(IMR) and leaflet prolapse or rheumatic in 28 cases (AMR). Mitral regurgitation was moderate to severe in all cases. RESULTS: All of the sixty nine patients underwent coronary artery bypass graft with a mean of 2.8짹1.3 grafts(IMR; 3.2짹1.1 vs. AMR; 2.5짹1.5). The regurgitation grade was decreased from 3.6짹0.6(3.5짹 0.7 vs. 3.7짹0.4) to 1.3짹1.2(1.3짹1.3 vs. 1.4짹1.1) after operation. The changes of left ventricular end-systolic, end-diastolic volumes and LV ejection fraction were not different between two group (p=NS; generalized linear model ANOVA). Cumulative survival at a 118-month follow-up was 72.3짹0.13 % (69.7짹 0.16% vs. 86.1짹0.06%, p=0.72). CONCLUSION: There was no significant difference in postoperative outcome between patients with either IMR or AMR. These findings suggest that complete revascularization and aggressive mitral valve procedure including ventricular reconstruction for IMR should be considered for patients with ischemic mitral insufficiency and it provides comparable outcome.