Innovative approach provides optimal functional outcomes

Only a few US centers have the surgical expertise to carry out the most challenging heart repairs in neonates and infants. With the arrival of neonatal cardiothoracic surgeon Christopher J. Knott-Craig, MB, ChB, chief of UAB’s Section of Pediatric Cardiac Surgery, even the youngest and most complex patients can now have their cardiac defects safely repaired at UAB.

Advanced techniques mean surgeons are repairing cardiac conditions in increasingly younger patients, offering babies the best chance for normal development, Knott-Craig says. “We now perform surgeries in premature infants who weigh less than 2 lb. Correcting defects at birth gives the brain and other organs full benefit of a functional heart. And, while scientists have thought that heart cells cannot regenerate, we have found that during the first 4 months of life, the heart can remodel and rebuild itself to a certain degree, which means patients can potentially heal with minimal permanent cardiac scars.”

An iconoclastic surgeon who has bucked medical dogma in pursuit of optimal long-term functional outcomes, Knott-Craig has introduced novel strategies in surgical and postoperative settings. Some of these techniques, such as giving blood during pediatric cardiopulmonary bypass, are now standard treatment. “I proactively protect patients’ brains and other vital organs to ensure that years down the road, they achieve the highest level of function possible,” he says. “That means creating an ICU setting favorable to healing and developing.”

Music for Their Ears
Putting himself in the place of his tiny patients, Knott-Craig has banned bright lights, disturbing noises, and pain common to pediatric intensive care units (ICU). “We pad babies’ eyes so they are protected from heating lamps and not disturbed by flashing equipment,” he explains.

Babies in Knott-Craig’s ICU also wear headphones that pipe in Mozart, music conducive to relaxation and associated with building mathematical skills, he says. “Many of these infants spend their first weeks in an ICU — arguably the most formative period of their lives. We try to provide the stimulation needed for normal development.”

Preventing pain, rather than reacting to it, also is a key component of Knott-Craig’s philosophy. Once children leave the operating room, needles are not allowed and patients receive continuous infusions of low-dose narcotics and anxiolytics to prevent the fear that makes recovery from cardiac surgery such a difficult experience for both patients and their parents.

Overcoming Complex Conditions
Knott-Craig, who in 1994 accomplished the first successful neonatal repair of Ebstein’s anomaly — a rare, often fatal condition characterized by structural deformity of the tricuspid valve, massive cardiomegaly, small lungs, and high pulmonary resistance — also corrects more common cardiac defects including hypoplastic left heart syndrome, transposition of the great arteries, and atrioventricular canal. He also performs endoscopic thoracic sympathectomy for hyperhydrosis, a procedure he says is underutilized in favor of less-effective medical therapies.

“I feel one should not accept that a problem is impossible to overcome,” he says. “Instead, it is important to challenge oneself to overcome the problem by confronting it with an open mind and simplifying it into more easily manageable subparts.”

For more information
Dr. Christopher Knott-Craig
1.800.UAB.MIST
mist@uabmc.edu