{"id":5682,"date":"2026-08-21T08:28:10","date_gmt":"2026-08-21T06:28:10","guid":{"rendered":"https:\/\/cvja.co.za\/journal\/?p=5682"},"modified":"2026-08-25T15:26:04","modified_gmt":"2026-08-25T13:26:04","slug":"cvja-2026-039","status":"publish","type":"post","link":"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/","title":{"rendered":"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic"},"content":{"rendered":"
\r\n
\r\n
\r\n \r\n \r\nMehmet Sanser Ates, Zumrut Tuba Demirozu\r\n<\/div> \r\n<\/div> \r\n
\r\n Copyright:<\/strong> Clinics Cardive Publishing (Pty) Ltd. publisher\r\n of Cardiovascular Journal of Africa.<\/div>\r\n
<\/div> \r\n
\r\n
\r\n Abstract \r\n <\/div> \r\n \r\n
\r\n \r\n \r\n \r\n \r\n\r\n Background:<\/strong> \r\n \r\nOff-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.\r\n
\r\n\r\n Case presentation:<\/strong> \r\n \r\nA 71-year-old male with a 10-year history of chronic interstitial pulmonary fibrosis presented with exertional dyspnoea. Coronary angiography and transthoracic echocardiography revealed two-vessel disease. Based on preoperative pulmonary function tests and the high risk of prolonged endotracheal intubation, the patient was deemed a high-risk candidate for general anaesthesia. In July 2020, during the COVID-19 pandemic, he underwent awake off-pump no-touch aorta double coronary artery bypass grafting using arterial revascularisation under TEA. The patient's recovery was uneventful, and he was discharged on the fifth postoperative day.\r\n
\r\n \r\n \r\n Conclusion:<\/strong> \r\n \r\nAwake OPCABG under TEA is a viable strategy for elderly patients with severe interstitial lung disease who face substantial risks from conventional cardiopulmonary bypass. This complex approach should be restricted to referral centres with extensive experience in advanced off-pump surgery and thoracic epidural anaesthesia.\r\n
\r\n \r\n\r\n \r\n <\/div> \r\n <\/div> \r\n \r\n \r\n
\r\n \r\n Keywords:<\/strong> \r\n \r\n off-pump coronary artery bypass grafting, no-touch aorta, awake CABG, thoracic epidural anaesthesia<\/strong> \r\n \r\n <\/div> \r\n \r\n
\r\n \r\n Submitted:<\/strong> September 29, 2025; \r\n Accepted:<\/strong> June 15, 2026; \r\n Published:<\/strong> August 11, 2026
\r\n Cardiovasc J Afr 2025; 37<\/b>: 354-357<\/em>\r\n
Volume 37, Issue 3<\/strong>
\r\n <\/div> \r\n \r\n
\r\n DOI Citation Reference: dx.doi.org\/10.5830\/CVJA-2026-039 \r\n <\/div> \r\n \r\n
\r\n\r\n\r\nDepartment of Cardiovascular Surgery, Ko\u00e7 University School of Medicine, Istanbul, T\u00fcrkiye\r\n\r\n<\/strong>
\r\nMehmet Sanser Ates
\r\nZumrut Tuba Demirozu\r\n

\r\n \r\n\r\n [soshsc hide=\"logged\"]\r\n\t\t\t\t\r\n You need to be logged in to view and download<\/a> the full text PDF version. Register for a free account?<\/a><\/strong>

[\/soshsc]\r\n \r\n \r\n \r\n <\/div>\r\n \r\n<\/div>","protected":false},"excerpt":{"rendered":"

Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[44,111],"tags":[],"class_list":["post-5682","post","type-post","status-publish","format-standard","hentry","category-cardiovascular-topics","category-volume-37-issue-3"],"yoast_head":"\nAwake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic - Cardiovascular Journal of Africa<\/title>\n<meta name=\"description\" content=\"Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic - Cardiovascular Journal of Africa\" \/>\n<meta property=\"og:description\" content=\"Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiovascular Journal of Africa\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-21T06:28:10+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-25T13:26:04+00:00\" \/>\n<meta name=\"author\" content=\"Jaco Moolman\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jaco Moolman\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/\",\"url\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/\",\"name\":\"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic - Cardiovascular Journal of Africa\",\"isPartOf\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/#website\"},\"datePublished\":\"2026-08-21T06:28:10+00:00\",\"dateModified\":\"2026-08-25T13:26:04+00:00\",\"author\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920\"},\"description\":\"Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.\",\"breadcrumb\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cvja.co.za\/journal\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cvja.co.za\/journal\/#website\",\"url\":\"https:\/\/cvja.co.za\/journal\/\",\"name\":\"Cardiovascular Journal of Africa\",\"description\":\"The Cardiovascular Journal of Africa is a peer-reviewed medical journal publishing leading research in cardiovascular health across Africa since 1990\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/cvja.co.za\/journal\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920\",\"name\":\"Jaco Moolman\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g\",\"caption\":\"Jaco Moolman\"},\"url\":\"https:\/\/cvja.co.za\/journal\/author\/jacodesignconnection-co-za\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic - Cardiovascular Journal of Africa","description":"Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/","og_locale":"en_US","og_type":"article","og_title":"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic - Cardiovascular Journal of Africa","og_description":"Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.","og_url":"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/","og_site_name":"Cardiovascular Journal of Africa","article_published_time":"2026-08-21T06:28:10+00:00","article_modified_time":"2026-08-25T13:26:04+00:00","author":"Jaco Moolman","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Jaco Moolman","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/","url":"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/","name":"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic - Cardiovascular Journal of Africa","isPartOf":{"@id":"https:\/\/cvja.co.za\/journal\/#website"},"datePublished":"2026-08-21T06:28:10+00:00","dateModified":"2026-08-25T13:26:04+00:00","author":{"@id":"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920"},"description":"Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious chronic respiratory or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia.","breadcrumb":{"@id":"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/cvja.co.za\/journal\/cvja-2026-039\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/cvja.co.za\/journal\/cvja-2026-039\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/cvja.co.za\/journal\/"},{"@type":"ListItem","position":2,"name":"Awake off-pump no-touch aorta coronary artery bypass grafting in a patient with interstitial lung disease during the COVID-19 pandemic"}]},{"@type":"WebSite","@id":"https:\/\/cvja.co.za\/journal\/#website","url":"https:\/\/cvja.co.za\/journal\/","name":"Cardiovascular Journal of Africa","description":"The Cardiovascular Journal of Africa is a peer-reviewed medical journal publishing leading research in cardiovascular health across Africa since 1990","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/cvja.co.za\/journal\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920","name":"Jaco Moolman","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/454c6719ed785bfd40e036ca3c3ac3347c56b4a99902df8beb62d882b1e6967f?s=96&d=mm&r=g","caption":"Jaco Moolman"},"url":"https:\/\/cvja.co.za\/journal\/author\/jacodesignconnection-co-za\/"}]}},"_links":{"self":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts\/5682","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/comments?post=5682"}],"version-history":[{"count":5,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts\/5682\/revisions"}],"predecessor-version":[{"id":5690,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/posts\/5682\/revisions\/5690"}],"wp:attachment":[{"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/media?parent=5682"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/categories?post=5682"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cvja.co.za\/journal\/wp-json\/wp\/v2\/tags?post=5682"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}