(CNN) – When 34-year-old Davey Bauer’s lungs stopped working, doctors resorted to an unusual tool to keep him alive: large breast implants.
Experts say it was an innovative solution to give Bauer’s body time to fight off a nasty infection so he could tolerate a life-saving double lung transplant. It may be the first case of a possible transplant practice that could save people with infectious diseases who likely would not have survived just a few years ago.
Bauer’s case began in April when he felt like he couldn’t catch his breath. The avid snow and skateboarder has always been healthy. He stayed in good shape and maintained a healthy weight by working in landscaping in De Soto, Missouri. But he had been a smoker for a long time and started smoking a pack of cigarettes a day when he was 21. In 2014, he switched to vaping.
“I thought it was the healthier option,” Bauer said. “But honestly, I found it more addictive than cigarettes.”
When people smoke or vape, inflammation of the lung tissue can occur, making the organ more susceptible to infection. Plus, Bauer said, he hasn’t gotten a flu shot and it’s still flu season.
“All of these risk factors coincided: impairment of lung health from cigarettes and e-cigarettes, lack of vaccination against the flu and then an infection,” said Bauer’s doctor, Dr. Ankit Bharat, chief of thoracic surgery and director of the Canning Thoracic Institute at Northwestern Medicine. “Everything is right, and then a major catastrophe threatens.”
When Bauer’s breathing difficulties continued, he went to the doctor and tests revealed he had the flu. His breathing problems became so severe that he had to be admitted to a hospital in St. Louis. He also developed an additional lung infection that antibiotics could not cure.
The damage to his lungs became so severe that doctors put him on extracorporeal membrane oxygenation, or ECMO, a device that pumped and oxygenated Bauer’s blood from outside his body. The device is designed to give a patient’s lungs and heart a chance to rest so they can heal. However, in this case this was not enough.
Doctors determined his only hope would be a double lung transplant. They transferred Bauer to Northwestern Memorial Hospital in Chicago, but his condition deteriorated again.
“The day after he arrived, he basically programmed. His heart stopped. They perform cardiopulmonary resuscitation on him. That’s how sick he was,” said Bharat.
It’s a different challenge than a typical lung transplant, he said. People who need a transplant often have a chronic condition, such as emphysema or cystic fibrosis, that develops over time. Doctors can plan and patients can work to be as healthy as possible in their condition and can wait for a donor to become available. In this case, doctors remove a person’s damaged lungs if they have donor lungs and replace them immediately. But that wasn’t the case with Bauer.
He had acute respiratory failure. He didn’t have time to wait for a donor – and yet he was too sick to undergo a transplant.
“Someone who is actively dying and was as sick as David generally has no option for a transplant and generally just dies,” Bharat said. “We had to develop a strategy to do something we had never done before.”
Bharat has a history of successful double lung transplants in people with severe infections and even late-stage cancer. In June 2020, he and surgeons from Northwestern Medicine performed the first known double lung transplant on a Covid-19 patient in the United States. The patient survived and was discharged from the hospital. A similar approach could be applied here.
But the first challenge they had to overcome was the infection.
“When we opened the chest it was full of pus, just yellow, foul-smelling things,” said Bharat. Surgeons carefully removed the lung so as not to spread germs and cleaned out anything that appeared to contain the infection. They also kept Bauer on strong antibiotics.
They thought it might take weeks, but within a few days his body seemed to have overcome the infection.
“He miraculously started looking really good and we thought we could make the transfer,” Bharat said.
Another problem was maintaining Bauer’s blood flow while they waited for the infection to clear so his body could be ready for the donor lung.
The heart and lungs work together through the heart’s two pumps, which are connected to each other on the right and left sides. Blood flows through the lungs from right to left.
Bharat described it as a highway going in one direction to the right from the heart to the lungs and another highway going back to the left side. In a body, organs return blood to the right side of the heart, which pumps it to the lungs. The lungs take in oxygen and remove carbon dioxide. Then this highway system directs it back to the left side of the heart, which pumps the blood to the rest of the body, which sends it back to the heart, and the circulation continues.
Taking out the lungs destroys the highway system and there is no connection between right and left. “This is not a survivable situation,” Bharat said.
Doctors had to use parts of the ECMO machine to create artificial channels to move blood through Bauer’s body.
“I was thinking all night about how I was going to create these channels and do all these things,” Bharat said.
The final challenge was what to do with the heart. It is located in the middle of the body and although it is attached to several blood vessels, it is “floppy,” said Bharat.
“If the patient turns, they can fall on their side and so on and twist everything, so we had to develop a mechanism to just keep the heart in the middle,” said Bharat.
Lab sponges weren’t big enough, he said, and they needed something that could be molded into his chest. This is where the breast implants came into play: Double-D implants in his chest cavity managed to temporarily keep the heart where it should be.
The entire process only took a few days. On May 26, doctors removed Bauer’s lungs and a pair of donors were available the next day. On May 28, surgeons removed the placeholder breast implants and inserted the donor lung.
The Northwestern team told Bauer’s family that this was by far one of the most complex cases they had ever seen.
“He is on the road to a full recovery and it is truly amazing for us to see,” said Bharat.
The procedure carries real risks, even greater than those seen in a typical lung transplant, Dr. However, Yoshiya Toyoda, surgical director of thoracic transplantation, chief of cardiovascular surgery and chief of mechanical circulatory support at Temple University Hospital, was not involved in Bauer’s case.
A typical lung transplant involves only one operation to remove the lung and insert the donated organ. Any surgery carries serious risks, and Bauer’s case involved multiple procedures. Using a man-made system to maintain blood flow also carries the risk of blood clots forming, which can cause a stroke. “This is another disadvantage of this approach,” Toyoda said. But he added: “I want to congratulate them because it was successful.”
According to the family’s Gofundme page, Bauer was already sitting in June and was able to breathe on his own for a few hours. By mid-June, he was off his ventilators and breathing with his new lungs.
It took several months in the intensive care unit for him to recover, but by the end of September he was well enough to be discharged and continue therapy at a rehabilitation facility outside the hospital.
Dr. Albert Rizzo, chief medical officer of the American Lung Association, said the success of his recovery was remarkable and the technique used by doctors was innovative.
“I spoke to some transplant surgeons yesterday and they think it was innovative as well,” he said. “It really sounds like an ingenious way to solve a problem.”
Unfortunately, Bauer likely won’t be able to attend Opening Day at Busch Stadium next spring to watch his beloved St. Louis Cardinals. He must remain in Chicago for the next year so that his doctors at Northwestern can monitor him closely.
His doctors said they haven’t yet succeeded in turning Bauer into a Chicago Cubs fan, but he has embraced the innovation of their efforts to save him.
He told doctors at Northwestern that he was having all of his gaming profiles changed and a T-shirt made with his new nickname: “DD Davey.”
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