Between January 1996 and December 1998, 68 consecutive patients underwent combined coronary artery bypass and mitral valve surgery for ischemic mitral insufficiency. The 63 patients who underwent mitral valve repair (84% by suture annuloplasty) were reviewed. The operative mortality rate (12.7%) was comparable with that in other reports. On discharge, 98.2% of patients were in NYHA class I or II. Follow up (range: 1-35 months) was complete in 95% of patients. The risk of residual postoperative moderate mitral regurgitation on discharge (16% of operative survivors) was related to preoperative severe mitral regurgitation and poor left ventricular ejection fraction, and was predictive of poor long-term outcome. Poor outcome was also related to the surgeon's experience. Structural valvular deterioration was noted in 21.8% of operative survivors; there was one reoperation and four late deaths. The survival rate (inclusive of operative deaths) at 35 months was 68.3 ± 13.1%, and event-free survival rate (no mortality, reoperation or angina) was 65.2 ± 6.2%.