Background: Ischemic mitral regurgitation (IMR) frequently occurs as a complication following a myocardial infarction (MI). Aim and objectives: To compare the results of mitral valve repair and replacement in cases with ischemic mitral regurgitation who receive revascularization. Patients and methods: This analytic comparative cross-sectional research was performed on 88 cases with ischemic mitral regurgitation attending the department of cardiothoracic surgery at Suez Canal University Hospital in Ismailia and at Nasser Institute in Cairo. Cases were separated into 2 groups: Group I: 44 cases received mitral valve repair and Group II: 44 cases received mitral valve replacement. Results: 3 cases in the mitral valve repair group showed early mortality and 8 patients showed late mortality. While 6 patients in the mitral valve replacement group showed early mortality, 12 patients showed late mortality. The mean preoperative EF in the mitral valve repair group was 48.86 ± 13.78, and the median was 49 (0.46 82). While in the MVR group, the mean preoperative EF was 46.04 ± 6.08. The data showed statistically significant variance among both groups regarding early mortality and late mortality and a highly statistically significant difference regarding postoperative ejection fraction (EF). Conclusion: In our study, mitral valve repair may be comparable to MVR regarding long-term survival and early mortality. Nevertheless, one year after the mitral valve repair operation, there was a higher risk of persistent or recurrent mitral regurgitation.