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When 34-year-old Davey Bauer’s lungs stopped working, doctors turned to an unusual tool to help keep him alive: large breast implants.
Giving Bauer time to fight off a deadly infection and allowing him to receive a life-saving double lung transplant was a novel solution, experts say. could be Be the first example of a transplant practice that can save people with infectious diseases who might not have survived years ago.
Bauer’s case It started in April, when he felt unable to control his breathing. An avid ice- and skateboarder was always healthy. He maintains his good shape and healthy weight by working in landscaping in De Soto, Missouri. But he started smoking at the age of 21 and was a long time smoker. Switched to vaping in 2014.
“I thought it was a healthy option,” Bauer said. But, to be honest, I find it more addictive than cigarettes.
When people Smoking or vapingIt can cause the lung tissue to burn, making the organs more inflamed Exposed to infection. Plus, Bauer said, he hasn’t gotten a flu shot, and it’s still flu season.
“All of these risk factors are fixed: lung health related to smoking and breathing, not getting the flu shot and then you get an infection,” says Bauer physician Dr. Ankit Bharat, chief of thoracic surgery and director of the Canning Thoracic Institute at Northwestern Medicine. “Everything gets fixed, and then you’re set for a big disaster.”
When Bauer continued to have trouble breathing, he went to the doctor and tests revealed he had the flu. His breathing became so bad that he had to be hospitalized in St. Louis. He also developed Additional lung infections that won’t clear up with antibiotics.
The damage to the lungs is so extensive that doctors may prescribe extracorporeal membrane oxygenation, or ECMO. device It pumped Bauer’s blood out of his body and oxygenated it. The device is designed to give the patient’s lungs and heart a chance to rest and heal, but in this case it wasn’t enough.
Doctors decided his only hope would be a double lung transplant. Bauer was transferred to Northwestern Memorial Hospital in Chicago, but his condition worsened.
“The day after he arrived, he basically coded. His heart stopped. They are doing CPR on him. That was how he got sick,” Bharat said.
It was a different challenge than a typical lung transplant, he said. People who need a transplant often have a chronic disease that develops over time, such as emphysema or cystic fibrosis. Doctors can plan, and patients can wait until a donor is available, depending on their health status. At this time, when doctors have donor lungs, they remove the injured person and replace them immediately. But this was not the case with Bauer.
He had acute lung problems. He didn’t have time to wait for a donor – but he was too sick to go through with the transplant process.
“Someone who dies awake and is as sick as David generally doesn’t have the option of a transplant and generally dies,” Bharat said. “We had to come up with a strategy to do something we hadn’t done before.”
Bharath has a track record of successful treatment of serious infections and even double lung transplants. Late cancer. In June 2020, he and Northwestern Medicine surgeons did First known A two-lung transplant in a patient with Covid-19 in the US survived and was released from the hospital. You can use the same method here.
But the first challenge they had to overcome was the infection.
“When we opened our chest, it was full of pus, just yellow, foul smelling,” Bharat said. Surgeons carefully remove the lungs and clean everything, which seems to contain the infection, so as not to spread any germs. They also put Bauer on heavy antibiotics.
They thought it might take weeks, but within two days his body seemed to clear the infection.
“It started looking really good, miraculously, and we thought we could do the transfer,” Bharat said.
Another problem was how to keep Bauer’s blood flowing while he waited for the infection to clear so his body would be ready for donor lungs.
The heart and lungs work together through the two pumps of the heart, which are connected to each other on the right and left sides. The blood goes from right to left through the lungs.
Bharat describes it as a one-way highway, going right from the heart to the lungs and back to the left. The organs in the body return the blood to the right side of the heart, which pumps it into the lungs. Lungs take in oxygen and exhale carbon dioxide. This circulatory system then transfers it 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 cycle continues.
Exhaling the lungs destroys the airway system, there is no connection between the right and left. “This is not a curable condition,” Bharat said.
Doctors had to use parts of the ECMO machine to move the blood around Bauer’s body.
“I stayed up all night thinking about how to create these channels and do all these things,” Bharath said.
The final test was what to do with the heart. It is in the center of the body, and although it is connected to many blood vessels, Bharat, it is “floppy”.
“When the patient turns, it falls to one side and rotates everything, so we had to create a method to keep the heart only in the center,” Bharat said.
Laboratory sponges were not enough, and they needed something to be carved into the chest. That’s where breast implants come in: Double-D implants The space in his chest temporarily held the heart in place.
The whole process took only a few days. Doctors removed Bauer’s lung on May 26, and a donor pair was found the next day. On May 28, surgeons removed the breast substitute and inserted the donor lung.
The team at Northwestern told the Bauer family it was one of the most complex cases they had ever seen.
“He’s on the road to a full recovery, and it’s a wonderful thing for us to see,” Bharat said.
The procedure comes with real risks, even greater than those seen with conventional lung transplants, said Dr. Yoshia Toyoda, director of chest transplant surgery, chief of cardiovascular surgery and director of mechanical circulatory support at Temple University Hospital. Related to the Bauer case.
A typical lung transplant involves only one operation, to remove the lung and insert the donated organ. All surgeries come with serious risks, and Bauer’s case involved multiple procedures. Artificially blocking blood circulation can also cause blood clots that can lead to stroke. “This is another disadvantage of this approach,” Toyoda said. But, he added, “I want to congratulate him on his success.”
By June, Bauer was already sitting up, and breathing on his own for a few hours, according to the family’s GoFundme page. By mid-June, he was off the ventilator and breathing with his new lungs.
It took several months in intensive care to recover, but by the end of September, he was well enough to be discharged and continue his rehabilitation outside the hospital.
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Dr. Albert Rizzo, chief medical officer of the American Lung Association, said their recovery success was remarkable and the method used by doctors was innovative.
“I talked to some transplant surgeons yesterday, and they feel it’s innovative,” he said. “Sounds like a really clever way to solve a problem.”
Unfortunately, Bauer won’t be able to attend Opening Day at Busch Stadium next spring to see his beloved St. Louis Cardinals. He will have to stay around Chicago for the next year so that his doctors at Northwestern can keep a close eye on him.
Doctors said they couldn’t turn Bauer into a Chicago Cubs fan, and his efforts to save him took a new turn.
He told Northwestern doctors that he was changing all of his playing profiles and donning t-shirts with his new nickname, “DD Davey.”