"I Chatted and joked with the surgeons as they carried out my heart bypass"

It was the first time the complex operation had been attempted in Britain without a general anaesthetic. For 90 minutes, John Phillipson lay wide awake as his team of surgeons performed the ground breaking heart bypass on him. And the 72 year old father of three even cracked a few jokes to make sure his doctors didn't lose their focus.

Mr Phillipson was given only a local anaesthetic to numb his chest and his heart kept beating during the keyhole surgery.

"When you think about it, it's better to be awake while they are doing the operation - because you know you will still be awake at the end of it," he said.

"I could feel pressure on my chest where the surgeon worked, but it didn't hurt. "It was very strange, lying there watching them, although they put up a screen so I couldn't see what they were doing. "I was chatting away and they asked me if I knew any good jokes - so I had to rack my brains to think of some clean ones!"

Mr Phillipson, a retired engineer from Watford, was left with a neat 5 inch scar and recovered so quickly that he was able to sit up and read that afternoon. Instead of a general anaesthetic he had an epidural injection in the spine, similar to that given to millions of women during childbirth.

For conventional bypass operations, surgeons have to split the breastbone to get to the heart, which is then stopped and the patient's blood circulated through a heart-lung machine. The recovery time is normally about double the three days which Mr Phillipson spent this month at Harefield Hospital, Middlesex, part of the Royal Brompton NHS Trust, London.

Consultant cardiac surgeon Mohamed Amrani said the success of the operation shows it is better for patients and could save money for the NHS. Mr Phillipson was the first of four patients to have a wide-awake bypass - but many more could benefit in the future, he added.

"We are delighted with the success of the surgery under epidural" said Mr Amrani. "Our first patient, who was operated on in the morning was sitting up, eating and reading the newspaper by the afternoon. It means we can eliminate three invasive procedures used for a bypass making it more comfortable and safer for patients.

"We don't have to do an incision through the breastbone or use a heart-lung machine which can have side-effects. Doing away with a general anesthetics means patients can recover more quickly. A significant number are more scared of that than being awake during surgery. There is an intrinsic fear of not waking up afterwards".

The epidural injection is administered near the top of the spine. Medical advances have made it possible for drugs to be strong enough to numb the pain while still allowing some chest movement to facilitate surgery.

Mr Amrani said it could benefit patients who are not well enough to have open-heart surgery. He plans to do triple and quadruple bypasses using the technique.

Mr Phillipson who had a heart attack in January 2003, added: "I can't believe how well I feel.

Spare Part Plumbing that clears artery blockage

Coronary artery bypass surgery is one of the most common heart operations, with around 25,000 - 33,000 carried out each year in Britain. Ninety-nine patients out of a hundred will survive surgery. In conventional operations, the chest is split open under deep anaesthesia. Surgeons take a piece of vein from the leg or arm and plumb it into the heart to bypass the clogged artery.

During the procedure, a heart-lung machine takes over from the heart, pumping blood round the body, and keeping the brains and kidneys supplied with oxygen. Patients are then looked after in intensive care and may have to be in hospital a week or more.

Their post-surgical risks include blood clots, heart rhythm problems, infection, collapsed lung and stroke - because 'sludge' from the artery has broken off and lodged in the brain.

Patients are generally off work for four to six weeks after the operation. However, more surgery may be needed 12 to 15 years later, because veins used in the bypass may wear out. The cost to the NHS is £5,000 to £20,000, depending on the number of arteries needing treatment.

The wide-awake operation offers savings because patients are in hospital for less time and have less risk of infection. It has been carried out in the U.S., Turkey and Germany.

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"I Chatted and joked with the surgeons as they carried out my heart bypass"

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