Obesity is not associated with increased risk for ICU mortality, but may be associated with lower hospital mortality. There is a critical lack of research on how obesity may affect complications of critical illness and patient long-term outcomes.

Hypertrophic cardiomyopathy (HCM) is a relatively common disorder that anesthesiologists encounter among patients in the perioperative period. Fifty years ago, HCM was thought to be an obscure disease. Today, however, our understanding and ability to diagnose patients with HCM have improved dramatically. Patients with HCM have genotypic and phenotypic variability. Indeed, a subgroup of these patients exhibits the HCM genotype but not the phenotype (left ventricular hypertrophy). There are a number of treatment modalities for these patients, including pharmacotherapy to control symptoms, implantable cardiac defibrillators to manage malignant arrhythmias, and surgical myectomy and septal ablation to decrease the left ventricular outflow obstruction. Accurate diagnosis is vital for the perioperative management of these patients. Diagnosis is most often made using echocardiographic assessment of left ventricular hypertrophy, left ventricular outflow tract gradients, systolic and diastolic function, and mitral valve anatomy and function. Cardiac magnetic resonance imaging also has a diagnostic role by determining the extent and location of left ventricular hypertrophy and the anatomic abnormalities of the mitral valve and papillary muscles. In this review on hypertrophic cardiomyopathy for the noncardiac anesthesiologist, we discuss the clinical presentation and genetic mutations associated with HCM, the critical role of echocardiography in the diagnosis and the assessment of surgical interventions, and the perioperative management of patients with HCM undergoing noncardiac surgery and management of the parturient with HCM.

SummaryImplantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require longterm outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access. This review discusses the mechanics of a continuous-flow LVAD (the HeartMate II), the effects of continuous blood flow on the kidney, renal outcomes of patients after LVAD implantation, dialysis modality selection, vascular access, hemodynamic monitoring during the dialytic procedure, and other issues relevant to caring for these patients.

Objectives The purpose of this study was to determine whether acute renal injury develops more frequently in women than in men after cardiac surgery and whether this complication is associated with operative mortality in women. Methods Prospectively collected data were evaluated from 9461 coronary artery bypass graft and/or cardiac valve surgery patients (3080 women) not on preoperative dialysis. Glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease equations using the last plasma creatinine before surgery (baseline) and the highest level of the first postoperative week. The primary renal injury outcome was the composite endpoint of renal injury according to RIFLE criteria (eGFR decrease > 50% from baseline) or failure. Results Thirty-day operative mortality and renal injury were more common in women than in men (5.9% vs 2.8%, P=0.01; 5.1% vs 3.6%, P<0.001, respectively). Nonetheless, patient sex was not independently associated with risk for renal injury when baseline eGFR was included in multivariate modeling. Perioperative complications, ICU length of stay, and mortality were more frequent for patients with than without renal injury (women, 20.6% vs 3.2%, P<0.0001; men, 18.3% vs 2.2%, P<0.001). Renal injury was independently associated with 30-day mortality for women (OR, 3.96; 95% CI, 1.86–8.44, P<0.0001) and men (OR, 4.05; 95% CI, 2.19–7.48, P<0.0001). Conclusions Postoperative renal injury is independently associated with 30-day mortality regardless of patient sex. Higher rates of renal injury in women compared with men might be explained in part by a higher prevalence of low eGFR before surgery. Ultra-Mini Abstract Renal injury is more common in women than in men after cardiac surgery. Regardless of patient sex, the development of this complication is independently associated with elevated 30-day mortality.