Stop Your Billowing

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Short case presentation
72 yo male with hx of CABG 18 years ago now with SVG to OM 100%, SVG to RCA 100%, LIMA to LAD patent, and RIMA to RCA patent with new onset systolic murmur, atrial fibrillation, and SOB/PND. He has a history of sleep apnea but refuses CPAP. The ECG shows SR, mutiple PVCs, and RBBB. His LVEF is 55%. He is on a beta blocker, lipid therapy, and his plavix was stopped 14 days ago and his coumadin was stopped 7 days ago.

Please discuss the pathology of the disease, the type of repair that can be performed and the results of each repair. Which repair method would you recommend for this patient?