Which procedure carries the highest risk for development of acute kidney injury requiring dialysis?

The combination of mitral valve replacement (MVR) and coronary artery bypass grafting (CABG) carries a particularly high risk for the development of acute kidney injury (AKI) requiring dialysis. Several factors contribute to this increased risk.

First, both procedures individually pose a risk for AKI due to factors such as intraoperative hypotension, cardiopulmonary bypass (CPB) effects, and potential embolic events. When these two interventions are combined, the cumulative effects of both surgeries can exacerbate the risk factors. The requirement for prolonged CPB during such combined procedures can lead to renal hypoperfusion and subsequent injury.

Additionally, patients undergoing MVR + CABG are often older and may have more comorbidities, such as pre-existing chronic kidney disease, diabetes, or heart failure, which further increases the likelihood of AKI. The stress of having multiple surgeries in a single operative setting, alongside potential variations in blood flow and increased fluid shifts, can overwhelm the kidneys.

Evaluating the other options, while mitral valve replacement or aortic valve replacement performed alone also carries risks for AKI, they do not combine the stressors of two significant surgeries, as in the case of MVR + CABG. On the other