Functional ischemic mitral regurgitation is one of the most challenging conditions to manage. Unlike organic mitral regurgitation where there is purely a mechanical problem, and correcting the mitral regurgitation either by mitral valve repair or replacement, results in a cure for most patients, functional ischemic mitral regurgitation has many pathologies, each of which must be adequately addressed to achieve the best outcome for the patient. These include the coronary artery disease, myocardial ischemia and myocardial infarction, left ventricular dilatation, dysfunction and scarring, and the tethering of the mitral valve apparatus, in addition to the mitral regurgitation. The problem is that not all of the pathologies can be effectively treated in every patient, and unlike in degenerative mitral regurgitation where excellent and durable valve repair techniques are in existence, in functional ischemic mitral regurgitation, a consistent, durable valve repair for every patient remains elusive. Although the technique of mitral valve repair by mitral annuloplasty is well established, and is efficacious in many cases of ischaemic mitral regurgitation, particularly if the mitral regurgitation is not too severe and the leaflets not too severely restricted, several studies have reported limited durability of this valve repair technique in cases of very severe mitral regurgitation, those with severe tethering of the mitral valve leaflets, and those with severely dilated left ventricles [1, 2]. Newer repair techniques on the subvalvular apparatus are in use to address the severely tethered leaflets, e.g., papillary muscle repositioning, but long term results of this is still awaited and studies comparing it to conventional mitral annuloplasty are needed [3].