Regional anaesthesia in the form of thoracic epidural anaesthesia (TEA) alone (awake cardiac anaesthesia) or combined with general anaesthesia (GA) has been used in cardiac surgical patients. One of the useful alternatives to TEA would be high spinal anaesthesia as the risk of haematoma associated with this procedure is much less than the epidural in cardiac surgical patients. The use of spinal anaesthesia in cardiac patients, particularly patients with stenotic valvular lesions has been for long viewed with much apprehension, primarily due to the perceived risk of hypotension as a result of sympatholysis. However, various studies using high spinal up to T1 level have proved such apprehensions to be invalid in the setting of cardiac surgery where patients are monitored intensively with invasive monitors and the hypotension managed at the earliest with the use of small aliquots or continuous infusion of vasoactive agents such as phenylephrine, norepinephrine, epinephrine, mephentermine as per the requirements of underlying cardiac lesion.