This interventional prospective randomized study is designed to compare hemodynamic management using postural mobilization (+/- noradrenaline) versus noradrenaline only in patients undergoing open-heart coronary artery bypass graft (CABG) surgery.

OPTICAB is a single-site study in France that aims to compare two hemodynamic management techniques during off-pump coronary artery bypass graft (CABG) surgery: postural mobilization (+/- noradrenaline) versus noradrenaline only. Primary objective is to evaluate how often noradrenaline is needed when managing hemodynamics using postural mobilization (passive leg raising) during off-pump CABG surgery. The study will also compare revascularization rate and post-operative complications among both groups, and assess perioperative hemodynamic management during the 30-day follow up period.

Inclusion Criteria:

• Adult patient
• patient requiring isolated coronary bypass surgery
• Elective procedure or medical emergency
• First cardiac surgery
• Patient with an EF ≥30%
• Mandatory affiliation to a social security system
• Signed informed consent form
• Suspension of renin-angiotensin system inhibitors and angiontensn-neprilysin receptor blockers and sartans the day before surgical procedure

Exclusion Criteria:

• Contraindication to an inotropic substance (only NA will be used)
• Contraindication to passive leg raising
• Patient in a life-threatening emergency
• History of cardiac surgery
• Bilateral iliac or common femoral artery occlusion
• EF < 30%
• Pregnancy and breastfeeding
• Renal failure (GFR < 40 ml/min/1.73 m²)
• Patient with bilateral thigh amputation
• Class III obesity BMI > 40 kg/m²

A plan has not yet been decided