(CNN) — When 34-year-old Davey Bauer’s lungs stopped working, doctors turned to an unusual tool to help him stay 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 accept a double lung transplant that would save his life. This may be the first example of a potential transplant practice that could save people with an infectious disease 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. This snow and skateboard enthusiast has always been in good health. He stayed fit and maintained a healthy weight while working in landscaping in De Soto, Missouri. But he had been a smoker for a long time, having started smoking a pack of cigarettes a day when he was 21. He turned to vaping in 2014.
“I thought it was the healthier alternative,” Bauer said. “But, in all honesty, I found it more addictive than cigarettes.”
When people smoke or vape, it can cause inflammation of lung tissue, making the organ more vulnerable to infection. Plus, Bauer said, he hadn’t gotten a flu shot and it was still flu season.
“All of these risk factors matched up: compromised lung health with cigarettes and vaping, not getting a flu shot and then you have an infection,” said Bauer’s physician, Dr. Ankit Bharat, chief of the Department of Thoracic Surgery and Director of the Canning Thoracic Institute at North West Medicine. “Everything lines up, and then you end up with a major disaster.”
When Bauer’s breathing problems persisted, he went to the doctor and tests showed he had the flu. His breathing problems became so severe that he had to be admitted to a St. Louis hospital. He also developed another lung infection that antibiotics failed to clear up.
The damage to his lungs became so severe that doctors put him on extracorporeal membrane oxygenation, or ECMO, a tool that pumped and oxygenated Bauer’s blood from outside his body. The device is designed to allow a patient’s lungs and heart to rest so they can heal, but that wasn’t enough in this case.
Doctors determined his only hope would be a double lung transplant. They transferred Bauer to Northwestern Memorial Hospital in Chicago, but his condition worsened further.
“The day after he arrived, he basically coded. His heart stopped. They give him resuscitation. That’s how sick he was,” Bharat said.
This is a different challenge than a typical lung transplant, he said. Often, people who need a transplant have a chronic illness like emphysema or cystic fibrosis that develops over time. Doctors can plan and patients can strive to be as healthy as possible in their condition and can wait until a donor becomes available. In this case, doctors remove damaged lungs from a person when they have donor lungs and replace them immediately. But that wasn’t the case for Bauer.
He suffered from acute lung failure. He didn’t have time to wait for a donor – and yet he was too ill to undergo a transplant.
“Someone who is dying and was so sick like David, usually won’t have any transplant options, and he will usually die,” Bharat said. “We had to strategize to do something we had never done before.”
Bharat has a history of successful double lung transplants on people with serious infections and even advanced cancer. In June 2020, he and surgeons at Northwestern Medicine performed the first known double lung transplant on a Covid-19 patient in the United States, and the patient survived and was released from the hospital. They could use a similar approach here.
But the first challenge they had to overcome was infection.
“When we opened the trunk, it was full of pus, just yellow, smelly stuff,” Bharat said. Surgeons carefully removed the lungs, so as not to spread germs, and cleaned everything, which appeared to contain the infection. They also kept Bauer on heavy antibiotics.
They thought it might take weeks, but within days his body seemed to have cleared the infection.
“He miraculously started looking really good and we thought we could do the transfer,” Bharat said.
Another problem was how to keep Bauer’s blood flowing while they waited for the infection to clear up so his body could be ready to receive the donor lungs.
The heart and lungs work together thanks to the two heart pumps, which are connected to each other on the right and left sides. Blood flows from right to left in the lungs.
Bharat described it as a highway going in one direction, on the right side, 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 road network returns it to the left side of the heart, which pumps blood to the rest of the body, which returns it to the heart, and the cycle continues.
Removing the lungs destroys the road network 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 spent all night thinking about how I’m going to create these channels and do all these things,” Bharat said.
The final challenge was what to do with the heart. It sits in the center of the body and, although it is attached to several blood vessels, Bharat said, it is “floppy.”
“When the patient turns around, they can fall to one side and so on and bend everything, so we had to create a mechanism to just hold the heart in the center,” Bharat said.
The lab sponges weren’t big enough, he said, and they needed something that could be molded inside his chest. That’s where breast implants came into play: Double-D implants inside her chest cavity managed to temporarily hold the heart where it was supposed to be.
The whole process only took a few days. Doctors removed Bauer’s lungs on May 26, and a pair of donors became available the next day. On May 28, surgeons removed the dummy breast implants and inserted the donor lungs.
The Northwestern team told Bauer’s family that this was by far one of the most complex cases they had ever seen.
“He’s on track to a full recovery, and it’s really amazing for us to see,” Bharat said.
The procedure carried real risks, even greater than one would see with a typical lung transplant, said Dr. Yoshiya Toyoda, surgical director of thoracic transplantation, chief of cardiovascular surgery and director of mechanical circulatory support at Temple University Hospital, which was not involved in Bauer’s case.
A typical lung transplant involves a single surgical procedure: removing the lung and inserting 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 developing clots that can cause a stroke. “This is another drawback of this approach,” Toyoda said. But, he added, “I want to congratulate them, because it is a success.”
By June, Bauer was already sitting up and able to breathe on his own for a few hours, according to the family’s Gofundme page. By mid-June, he had stopped his breathing machines and was breathing with his new lungs.
It took him several months in intensive care to recover, but by the end of September he was healthy enough to be discharged from the hospital and continue therapy at a rehabilitation center outside the hospital.
Dr. Albert Rizzo, chief medical officer of the American Lung Association, said the success of his recovery is remarkable and the technique doctors used was innovative.
“I talked to a few transplant surgeons yesterday, and they think it was innovative as well,” he said. “It really seems like an ingenious way to try to solve a problem.”
Unfortunately, Bauer likely won’t be able to make it to Opening Day at Busch Stadium next spring to watch his beloved St. Louis Cardinals. He must stay in Chicago for the next year so his doctors at Northwestern can monitor him closely.
His doctors said they had yet to convert Bauer into a Chicago Cubs fan, but he embraced innovation in their efforts to save him.
He told doctors at Northwestern that he was changing all his playing profiles and was having a T-shirt made with his new nickname: “DD Davey.”
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