In an innovative procedure recently, the diseased lungs of a 34-year-old American man were completely removed from his body, an “artificial lung” did their work, and two breast implants – size DD – served as placeholders in his chest cavity, supporting his heart. A day later, a second surgery transplanted donated lungs into his chest.
Afterwards, the patient, Davey Bauer, said if he had to go back in time, he might have gone for a flu shot, would definitely have said no to cigarettes, and never taken up the vaping habit.
“I’m lucky to be alive,” Bauer said recently. “I was given a second chance at life.”
Dr Ankit Bharat of Northwestern Medicine in Chicago came up with the idea for the innovative surgeries and tapped his colleagues in the plastic surgery department to help him figure out which implants to use.
“Davey’s case is remarkable because it shows that we can keep patients alive after removing their lungs through new technology,” says Bharat, chief of thoracic surgery and director of the Canning Thoracic Institute at Northwestern.
NPR reports that Bauer’s ordeal began in April when he contracted flu. His girlfriend, Susan Gore, insisted he get a prescription for antibiotics.
“The next day, he couldn’t walk,” Gore says. She took him to an emergency room and he was admitted to the hospital. But he deteriorated and was admitted to the intensive care unit.
A secondary bacterial infection had set into Bauer’s lungs, and antibiotics weren’t touching it. He had to be put on ECMO, the highest level of life support where blood is pumped outside the body for a machine to do the work of the heart and lungs.
Still, he continued to decline and his St Louis doctors started exploring transplant options.
“When we received a call from Davey’s medical team, we thought we could help him,” says Dr Rade Tomic, a pulmonologist and medical director of Northwestern’s lung transplant programme, “but it was also very clear he wouldn’t survive the transplant in his current condition.”
Bauer was transferred to Northwestern, and soon afterwards, his heart stopped and he had to be revived. He was too sick to be eligible for a transplant.
“He needed to clear the infection before we could list him for transplant, but the only way to do that was to remove both lungs,” Tomic says. “This was uncharted territory for us, but our team knew if we couldn’t help Davey, no one else could.”
Bharat and his colleagues started strategising. They could engineer part of the ECMO machine to do the work of his lungs. But lungs are large organs, and without them in the chest cavity, the heart could flop around.
“One of our plastic surgeons very graciously gave us a rapid-fire course on the different types, shapes and sizes of breast implants,” says Bharat, “so we picked out a couple of options.
“Some of them were easier than others to mould inside Davey’s chest, with the DD option being the best fit. We went with those.”
At this point, the Northwestern doctors didn’t know how long it would take Bauer to clear the infection or how long before donor lungs would be available.
During the first operation, which Northwestern filmed, Bharat marvelled at the weight of Bauer’s diseased lungs, heavy with the pus and fluid from infection.
The first operation on 26 May went well and his doctors were surprised at how quickly his young body cleared the infection. He was eligible for the transplant list within 24 hours.
The next surprise was how quickly donor lungs were available: the next day. On 28 May, Bharat performed the transplant operation. That too, went well.
“It still blows my mind,” Gore says. “I can’t believe Davey lived without any lungs. He was breathing, blood pumping, without lungs."
Dr Amit “Bobby” Mahajan, a spokesperson for the American Lung Association, says the case is “a very cool approach”. He sees a lot of potential for it to help cystic fibrosis patients.
“They are young and often have underlying infection,” says Mahajan, who is also a pulmonologist at Inova Fairfax Hospital. “This could support them to get them eligible for transplantation. The breast implants, in all honesty, are a very good idea for holding the anatomy together.”
Bharat, who had also performed a double lung transplant on a young woman with a catastrophic Covid-19 infection, is excited about the possibility of making more patients candidates for transplants.
“I never imagined we’d be using DD breast implants to help bridge a patient to lung transplantation,” he said, “but our team is known for taking on the most difficult cases and thinking outside the box to save lives.”
Bauer had no idea about the breast implants until he was recovering, and says he’s changing all of his gaming profiles to “DD Davey”.
Six months on, he says he is feeling better each day.
Though Tomic points out that there’s no evidence in Bauer’s specific case that vaping caused his problems, there is a strong body of evidence that vaping can cause lung injury, and that the vaping “certainly didn’t help”.
See more from MedicalBrief archives:
‘Piggy-backing’ extends human lung survival and healing
‘Popcorn Lung’ from vaping – First documented case in Canada
World first lung surgery saves Canadian woman’s life