Which surgical procedure carries the highest risk of requiring dialysis due to acute kidney injury?

The combination of mitral valve replacement with coronary artery bypass grafting (CABG) carries a notably higher risk of requiring dialysis due to acute kidney injury. This increase in risk is attributable to several factors associated with the complexity and invasiveness of the procedure.

Firstly, performing both a mitral valve replacement and CABG simultaneously results in a longer operative time and greater hemodynamic instability, particularly during cardiopulmonary bypass. The manipulation of the heart and vessels can lead to increased stress on renal perfusion, potentially resulting in ischemia to the kidneys.

Secondly, pre-existing conditions in patients undergoing this dual procedure may further contribute to kidney vulnerability. Many patients requiring such surgeries often have comorbidities such as diabetes, hypertension, or pre-existing chronic kidney disease, which already place them at a higher risk for acute kidney injury.

Additionally, the use of nephrotoxic medications and contrast agents during perioperative care can exacerbate kidney injury, especially when combined with the physiological stresses of more complex surgeries. With the increased demands placed on the kidneys during a dual procedure, the likelihood of acute kidney injury and subsequent need for dialysis rises significantly.

Thus, the combination of mitral valve replacement and CABG leads to a compounded risk that exceeds that of performing