Coronary artery Bypass (CABG): do we need it, do we need the mitral valve treated, will stents do?

I presented this case a learning- it is about 11 minutes long. A 62 year old man has "indigestion" that turns out to be a heart attack. I discuss his coronary disease: 1. How to assess if the narrowing/stenosis is severe -angiography -pressure wire -intravascular ultrasound 2. I discuss how to treat 3 vessel disease in a non diabetic Medical Therapy ONLY OR Medical Therapy plus: -full arterial revascularisation with surgery -a mixture of arteries and saphenous vein grafts -hybrid stent and surgery -all stents 3. I discuss what to do with the mitral valve that was leaking -leave it alone treat with a mitral valve ring to tighten it In the end a successful outcome, but this case illustrates how we make a decision when there is no one right answer.