When a 34-year-old man named Davey Bauer had a serious problem with his lungs, doctors did something unusual to help him stay alive: they used big breast implants. This was a clever idea to give Davey’s body a chance to fight off a bad infection, so it would be ready for a very important operation to replace both of his damaged lungs. This method might be the first time doctors tried something like this to save people with infections, who might not have made it in the past.
In April, Davey Bauer started having trouble breathing. He was normally a healthy person who enjoyed activities like snowboarding and skateboarding. He kept himself in good shape and had a healthy weight while working in landscaping in De Soto, Missouri. However, he had been smoking for a long time, starting with a pack of cigarettes a day when he was 21. In 2014, he switched to vaping, thinking it was a healthier option. But he found vaping to be even more addictive than cigarettes.
When people smoke or vape, it can make the tissue in their lungs swollen, which makes the lungs more likely to get infected. On top of that, Davey didn’t get a flu shot, and it was still flu season.
Davey’s doctor, Dr. Ankit Bharat, who is a specialist in chest surgery, explained that all these factors came together: the harm from smoking and vaping, not being protected against the flu, and then getting an infection. When all of these things happen at once, it sets the stage for a very serious problem.
When Davey Bauer’s difficulty in breathing didn’t get better, he went to the doctor. Tests showed he had the flu. His breathing got so bad that he had to stay in a hospital in St. Louis. He also got another infection in his lung that antibiotics couldn’t clear up.
His lungs were so damaged that doctors used a special tool called ECMO. It’s a machine that pumps and gives oxygen to Davey’s blood outside his body. This machine lets the patient’s heart and lungs rest so they can get better. But in Davey’s case, it wasn’t enough.
The doctors realized that Davey’s only chance to survive was to get new lungs through a double lung transplant. They moved him to Northwestern Memorial Hospital in Chicago, but things got even worse.
“The day after he got there, his heart basically stopped. They had to do CPR on him. That’s how sick he was,” explained Dr. Bharat.
This was a different kind of challenge compared to a usual lung transplant. Normally, people who need a transplant have a long-term lung problem that develops over time. Doctors and patients have time to plan and try to be as healthy as possible while waiting for a suitable donor. In those cases, doctors take out the person’s damaged lungs and replace them right away when they have donor lungs available. But for Davey, it was a different situation.
He had sudden and severe lung failure. He didn’t have time to wait for a donor, but he was also too sick to go through a transplant operation.
Usually, someone who is very sick like Davey and in danger of dying wouldn’t be able to get a transplant and would sadly pass away. Dr. Bharat explained, “We had to figure out a way to do something 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.
The first big problem they had to fix was the infection.
Dr. Bharat explained, “When we opened up Davey’s chest, it was filled with a yellow, smelly substance called pus.” Surgeons carefully removed his lungs to make sure no germs would spread, and they cleaned everything out really well. This seemed to get rid of the infection. They also gave Davey strong antibiotics to help.
They thought it might take a few weeks, but amazingly, in just a couple of days, Davey’s body seemed to have gotten rid of the infection.
But there was still another challenge. They needed to figure out a way to keep Davey’s blood moving through his body while they waited for the infection to completely go away, so his body would be ready for the new lungs.
Dr. Bharat explained that the heart and lungs work together like a team. There are two pumps in the heart, one on the right and one on the left, and they are connected to each other. The blood goes from the right side of the heart to the left side through the lungs.
He compared it to two highways: one goes from the heart to the lungs, and the other goes back to the heart. In the body, the organs make sure the blood gets back to the right side of the heart, which sends it to the lungs. The lungs add oxygen and take out carbon dioxide. Then the system sends the blood back to the left side of the heart, which sends it to the rest of the body, and the cycle starts again.
Removing the lungs would break this system, and there would be no connection between the right and left sides. Dr. Bharat said, “That’s not something a person can survive.”
So, the doctors had to use parts of the ECMO machine to make artificial channels to move the blood around Davey’s body.
The last challenge was what to do with the heart. It sits in the middle of the body and is attached to many blood vessels, but it’s not very stable. Dr. Bharat explained, “When the patient moves, it can shift to one side and cause problems, so we had to create a way to keep the heart in the middle.”
Regular sponges from a lab weren’t big enough, so they needed something that could be shaped inside Davey’s chest. That’s where the breast implants came in: Double-D implants in his chest managed to temporarily keep the heart where it needed 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.
Dr. Albert Rizzo, a top doctor at the American Lung Association, said that Davey’s recovery is impressive, and the method the doctors used was very clever.
He spoke with some surgeons who do transplants, and they also thought it was a creative idea. He said, “It really sounds like a smart way of trying to fix a problem.”
It’s a bit sad, but Davey probably won’t be able to make it to the first game of the baseball season at Busch Stadium next year to watch his favorite team, the St. Louis Cardinals. He needs to stay in Chicago for about a year so his doctors at Northwestern can keep a close eye on him.
Even though he hasn’t become a fan of the Chicago Cubs yet, his doctors are happy that he appreciates their creative efforts to save him.
Davey told the doctors at Northwestern that he’s going to change his gaming profiles and get a special t-shirt made with his new nickname: “DD Davey.”
SOURCE:CNN