The aim of this study was to compare the effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral insufficiency. The PICO strategy was used for data searching. After initial selection, we obtained 912 articles; 42 of these manuscripts were devoted to our issue. Considering the titles and abstracts, we selected 14 articles according to inclusion criteria. After analysis of full-text manuscripts, we excluded 9 publications due to lack of necessary data. Thus, 4 manuscripts were enrolled into final assessment. It was found that the most authors prefer mitral valve replacement due to the lower incidence of recurrent mitral insufficiency and redo surgeries. Moreover, both approaches are characterized by similar mortality rate and quality of life in long-term postoperative period.