When 34-year-old Davey Bauer’s lungs stopped working, doctors turned to an unusual tool to help 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 it could accept a lifesaving double lung transplant. It may be the first instance of a potential transplant practice that could save people with infectious disease who probably would not have survived just years ago.
Bauer’s case started in April, when he felt like he couldn’t catch his breath. The avid snow- and skateboarder had always been healthy. He kept in good shape and maintained a healthy weight working in landscaping in De Soto, Missouri. But he had long been a smoker, starting a pack-a-day cigarette habit when he was 21. He switched to vaping in 2014.
“I thought it was the healthier alternative,” Bauer said. ”But, in all honesty, I found it more addicting than cigarettes.”
“All these risk factors aligned: compromised lung health with the cigarettes and the vaping, not being vaccinated against the influenza and then you have infection,” said Bauer’s doctor Dr. Ankit Bharat, chief of thoracic surgery and director of the Canning Thoracic Institute at Northwestern Medicine. “Everything aligns, and then you’re set up for a major disaster.”
When Bauer’s breathing troubles continued, he went to the doctor, and tests showed that he had the flu. His breathing problems got so bad that he had to be admitted to a St. Louis hospital. He also developed an additional lung infection that antibiotics weren’t clearing up.
The damage to his lungs became so extensive 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 a chance to rest so they can heal, but it wasn’t enough in this case.
Doctors determined that his only hope would be a double lung transplant. They transferred Bauer to Northwestern Memorial Hospital in Chicago, but his condition took another turn for the worse.
“The day after he arrived, he basically coded. His heart stopped. They’re doing CPR on him. That’s how sick he was,” Bharat said.
It was a different kind of challenge from a typical lung transplant, he said. Often, people who need a transplant have a chronic condition like emphysema or cystic fibrosis that develops over time. Doctors can plan, and patients can work on being the healthiest they can be in their condition and can wait for a donor to become available. In that case, doctors take out a person’s damaged lungs when they have donor lungs and replace them right away. But this wasn’t the situation with Bauer.
He had acute lung failure. He didn’t have time to wait for a donor – and yet he was too sick to go through a transplant procedure.
“Someone who is actively dying and was so sick like David, generally, will have no option of transplant, and they generally just die,” Bharat said. “We had to come up with a strategy to do something that we’ve never done before.”
Bharat has a history of successful double lung transplants on people with severe infections and even late-stage cancer. In June 2020, he and Northwestern Medicine surgeons performed the first known double-lung transplant on a Covid-19 patient in the US, and the patient survived and was discharged from the hospital. They could use a similar approach here.
But the first challenge they had to overcome was the infection.
“When we opened the chest, it was full of pus, just yellow, nasty smelly things,” Bharat said. Surgeons removed the lungs carefully, so as not to spread any germs, and cleaned everything out, which seemed to contain the infection. They also kept Bauer on heavy antibiotics.
They thought it could take weeks, but within a couple of days, his body seemed to have cleared the infection.
“He miraculously started to look 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 so his body could be ready for the donor lungs.
The heart and lungs work together through the heart’s two pumps, which are attached to each other on the right and left side. The blood goes from the right to the left through the lungs.
Bharat described it like a highway going one direction, to the right side from the heart to the lungs, and another highway going back to the left side. In a body, the organs return the blood to the right side of the heart, which pumps it into the lungs. The lungs put oxygen in and take carbon dioxide out. Then this highway system turns 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 cycle goes on.
Taking out the lungs destroys the highway system, and there’s no connection between the right and left. “That’s not a survivable situation,” Bharat said.
Doctors had to use parts of the ECMO machine to create artificial channels to move the blood around Bauer’s body.
“I spent the whole 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’s in the center of the body, and although it’s attached to multiple blood vessels, Bharat said, it’s “floppy.”
“When the patient turns, it can fall on one side and so forth and kink everything, so we had to create a mechanism to just keep the heart in the center,” Bharat said.
Lab sponges weren’t big enough, he said, and they needed something that could be molded inside his chest. That’s where the breast implants came in: Double-D implants inside his chest cavity managed to temporarily keep the heart where it was supposed to be.
The entire process took only a few days. Doctors removed Bauer’s lungs May 26, and a donor pair became available the next day. On May 28, surgeons removed the placeholder breast implants and inserted the donor lungs.
The team at Northwestern told Bauer’s family that it was by far one of the most complex cases they had ever seen.
“He’s on track for full recovery, and it’s kind of really amazing for us to see,” Bharat said.
The procedure came with real risks, even bigger ones 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, who was not involved with Bauer’s case.
A typical lung transplant involves only one surgery, to remove the lung and put in the donated organ. All surgery comes with serious risk, and Bauer’s case involved multiple procedures. Using a human-made system to keep blood flowing also runs the risk of develop clots that could cause a stroke. “That’s another disadvantage with this approach,” Toyoda said. But, he added, “I want to congratulate them, because it was successful.”
By June, Bauer was already sitting up, and he was able to breathe on his own for a few hours at a time, according to the family’s Gofundme page. By mid-June, he was off his breathing machines and breathing with his new lungs.
It took several months in intensive care to recover, but by late September, he was healthy enough to be discharged and to continue with therapy in a rehab facility outside the hospital.
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Dr. Albert Rizzo, chief medical officer with the American Lung Association, said that the success of his recovery is notable and that the technique doctors used was innovative.
“I talked to a few transplant surgeons yesterday, and they feel it was innovative as well,” he said. “It really sounds like an ingenious way of trying to solve a problem.”
Unfortunately, Bauer won’t likely be able to go to opening day at Busch Stadium next spring to see his beloved St. Louis Cardinals. He has to stick around Chicago for the next year so his doctors at Northwestern can monitor him closely.
His doctors said they have not been able to convert Bauer into a Chicago Cubs fan yet, but he has embraced the innovation of their efforts to save him.
He told the doctors at Northwestern that he’s changing all his gaming profiles and getting a t-shirt made with his new nickname: “DD Davey.”