BoardsBridgeClinical Disease
cardiac
High-impact pattern
Off-Pump CABG (OPCAB) — Anesthetic Management
Beating-heart coronary bypass without CPB: hemodynamics, heparin strategy, AKI, and emergent conversion.
Off-pump CABG (OPCAB) avoids cardiopulmonary bypass and aortic cross-clamp but requires mechanical manipulation of the beating heart for each distal anastomosis — producing preload drops, RV compression, regional ischemia, and ST changes not seen during on-pump CABG.
If you forget
HEADLINE: OPCAB trades pump-related AKI/stroke risk for hemodynamic lability and lower graft patency
Board trap
Q: 'Does OPCAB reduce AKI?' Correct answer is 'yes, but qualified' — there IS a ~40% reduction in AKI odds, but the 33% dialysis-odds reduction is non-significant and graft patency is lower (82.6% vs 87.8%). KDIGO 2C forbids selecting OPCAB solely for renal protection. Saying 'no, never' misses the nuance; saying 'yes, always' misses the guideline.
Key numbers
- KDIGO Stage 1 AKI: ≥0.3 mg/dL creatinine rise in 48 h OR 1.5–1.9× baseline within 7 days
- OPCAB graft patency 82.6% vs on-pump 87.8% (P<0.01) — KDIGO Chapter 3.9
- OPCAB: ~40% lower AKI odds; 33% lower dialysis odds (non-significant)
- ACT target ≥300–350 s during anastomoses; reverse protamine only after final graft
- Maintain MAP ≥70–80 mmHg during each distal anastomosis to perfuse collaterals
- RCT of 2203 patients: no significant difference in 30-day composite outcome off-pump vs on-pump
Reviewed Sep 24, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: KDIGO AKI 2012 · KDIGO AKI 2012 · KDIGO AKI 2012 · KDIGO AKI 2012
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: cabg-off-pump · Path: aba.cardiac.ischemic.cabg-off-pump