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This retrospective observational study evaluated long-term survival in 212 patients undergoing restrictive mitral valve repair (MVr) with concomitant coronary artery bypass grafting (CABG) for moderate to moderately severe chronic ischemic mitral regurgitation (IMR). Actuarial survival was robust, reaching 87.3 percent at 12 years and 81.1 percent at 20 years. While univariate analysis demonstrated that diabetes mellitus significantly reduced survival at both 12 years (82.1 percent vs. 93 percent) and 20 years (71.4 percent vs. 93 percent), this effect became a non-significant trend in multivariate modeling. Ultimately, multivariate Cox regression identified postoperative residual mitral regurgitation (MR), incomplete coronary revascularization, and preoperative left ventricular end-systolic diameter (LVESD) ≥45 mm as the primary independent predictors of late mortality. The authors thus concluded that restrictive MVr combined with CABG confers durable long-term survival in chronic IMR, provided that revascularization is complete, residual regurgitation is meticulously avoided, and intervention precedes development of severe adverse ventricular remodeling.