Abstract Aim of the Study: We sought to determine the results of restrictive annuloplasty for chronic ischemic mitral regurgitation. Methods: Hospital outcome and serial clinical and echocardiographic (preoperative, discharge, 3 months, 12 months, 24 months) follow-up assessments were analyzed in 87 consecutive patients with chronic ischemic mitral regurgitation having coronary artery bypass grafting. Persistent/recurrent mitral regurgitation was defined by grade ≥2 at discharge/during follow-up. Results: Hospital mortality was 5.7% and persistence of regurgitation was present in 8.4%. Mean follow-up was 24.4 ± 1.7 months and recurrent mitral regurgitation was observed in 32.4% patients. In multivariate analysis only anterior leaflet angle remained an independent predictive factor for regurgitation recurrence with cutoff 27° (sensitivity of 67% and specificity of 76%, p = 0.04). Conclusion: There is high occurrence of early and delayed restrictive annuloplasty failure, particularly in patients with increased anterior leaflet tethering. (J Card Surg 2012;27:6-12)