Background: To assess the effects of mitral valve (MV) replacement for functional mitral regurgitation (FMR) in patients with severe left ventricular (LV) dysfunction. Methods: 48 patients with secondary non-ischemic severe mitral regurgitation (MR) and left ventricle eject fraction (LVEF) less than 35% were underwent MV replacement. All surgeries were finished by one surgical team from January 2010 to December 2015. Twenty-three patients were females and the mean age was 60.21 ± 10.69 years (range, 29～75 years). The preoperative cardiac function classification was Ⅲ~Ⅳ (NYHA) in 40 patients. The mean follow-up time was five years. Results: Three patients (6.3%) died in hospital: 2 from low output syndrome and 1 from multi-organ failure induced by pulmonary infection. The mean postoperative intensive care unit (ICU) stay time was 4 days. The mean cardiopulmonary bypass time was 131.50 ± 3.92 min, and the mean aortic cross-clamping time was 85.39 ± 24.16 min. The left atrium diameter and the systolic pulmonary artery pressure (PAP) decreased significantly after surgery. The survival rates at 1 and 5 years were 83.3% and 54.6%, and 29 patients (60.4 %) were in NYHA class Ⅰ/Ⅱ during the follow-up time. Conclusions: Mitral valve replacement maybe offers symptomatic improvement and mid-term survival benefit for non-ischemic FMR in some patients with severe LV dysfunction.