Chronic secondary mitral regurgitation (MR) has no definitive treatment because MR is only one component of the disease and restoration of mitral valve competence does not cure the condition. This study aimed to review recent advances in understanding of ischemic mitral regurge pathogenesis and to examine the numerous surgical techniques. Results: This was a retrospective non-randomized study conducted on 254 patients with coronary artery disease who underwent surgical procedures for the management of ischemic mitral regurge from January 2013 to December 2018. There was no statistically significant difference between two groups as regards in hospital mortality and late mortality p= 0.812, 0.760 respectively, there was significant improvement regarding the cardiac function examined by Ejection fraction (EF %) and the grade of mitral regurge p= 0.001 comparing pre-operative with post-operative status in repair group, there was a significant improvement regarding the cardiac function examined by Ejection fraction (EF %) comparing pre-operative with post-operative status and the grade of mitral regurge also showed no regurge p= 0.001 in replacement group. Conclusion: Both treatment methods significantly improve LV contractility, as shown by improvement in NYHA class in both groups and increase in EF%. MVR offers a better choice in cases with complex MR when repair seems unachievable