Davey Bauer’s lung infection was too life-threatening for a standard transplant. If doctors replaced his lungs with healthy ones right away, Bauer would not survive the surgery.
In April, shortly after contracting the flu, Bauer developed an antibiotic-resistant lung infection. The 34-year-old Missouri resident had a history of smoking cigarettes and also vaping for the past nine years.
St. Louis doctors put Bauer on a ventilator in a medically induced coma to help him breathe. But his condition continued to deteriorate.
Bauer was transferred to Northwestern Medicine in Chicago, where surgeons removed his lungs and used a life-support device called extracorporeal membrane oxygenation, or ECMO, to keep him alive while clearing the infection from his bloodstream.
However, there was still a problem: without lungs to physically support him, his heart would move or fall deeper into the chest cavity.
“Once we removed the lungs, we realized we now had to support the heart,” Bauer’s surgeon, Dr. Ankit Bharat, chief of thoracic surgery at Northwestern Medicine, said at a news conference Wednesday. “We were looking for the biggest thing that could fit in his chest cavity.”
They determined that the solution was a pair of DD breast implants.
According to Northwestern Medicine, this procedure is the first time breast implants have been used in a double lung transplant.
“I didn’t know much about this until after the fact, but I thought it was amazing and kind of fun,” Bauer said of the role the implants played in his procedure.
With the implants holding his heart in place, Bauer was able to clear the infection. Two days after his lungs were removed, doctors removed the implants and successfully transplanted healthy lungs from a donor into his body.
Bauer was released from the hospital in September and is now being monitored by his transplant team. He is expected to make a full recovery.
“I feel very blessed. It’s amazing,” he said Wednesday. “I have a second chance at life.”
An unusual method of transplant
Often, when a seriously ill patient is deemed too weak for a lung transplant, doctors may have no recourse.
But Northwestern surgeons built what amounted to an artificial lung that continued to supply oxygen to Bauer’s blood even after his lungs were removed.
The team placed several tubes into Bauer’s heart that diverted blood from his body to the ECMO machine. From there, the machine added oxygen to the blood (a job usually done by the lungs) and then sent the oxygenated blood back to the body, to the left side of his heart, which pumped it to the rest of his body.
“We wanted to maintain the natural blood flow in his body that would be present if his lungs were intact,” Bharat said.
Bauer’s partner, Susan Gore, said she can’t understand how he experienced the procedure.
“It still surprises me that he didn’t have lungs in his body but he was still alive,” he said.
Bharat said he hopes the technique can be used to save other patients who are too sick to receive transplants right away.
Keeping a patient alive without lungs is incredibly rare and requires a lot of expertise, but it’s not entirely novel, said Dr. John Michael Reynolds, a Duke Health transplant pulmonologist who was not involved in Bauer’s case.
“I had these implants, that’s what draws attention,” he said. “But that’s a very minor aspect of what was done.”
In 2019, Reynolds’ team at Duke similarly kept a lungless patient alive using artificial oxygen. The patient, a 30-year-old man with cystic fibrosis, underwent a double lung transplant six days later and eventually recovered.
Two years earlier, surgeons at the University of Toronto performed a similar procedure on another cystic fibrosis patient.
Dr. Brian Keller, medical director of the Lung Transplant Program at Massachusetts General Hospital, said doctors in general are improving their ability to transplant very sick patients, but many transplant centers don’t have the skills for a procedure like Bauer’s.
“There are very few centers in the world that would even attempt to do this,” he said.
No flu vaccine and a history of vaping.
Doctors can’t pinpoint exactly why Bauer developed a life-threatening infection at such a young age. Before the episode, Bauer had never been seriously ill. He liked snowboarding, skateboarding and golf.
“A lot of things lined up to get him to that point, because otherwise someone who is healthy, active and young like Davey almost shouldn’t have died from a flu infection,” Bharat said.
A complicating factor, Bharat said, is that Bauer had never received a flu vaccine. While the effectiveness of flu vaccines can vary from year to year, the vaccines generally reduce the risk of serious illness by 40% to 60% when they are well matched to circulating flu strains, according to the Centers for Disease Control and Prevention. Disease Control and Prevention.
Bharat said Bauer’s history of smoking and vaping may also have played a role, although it’s hard to say for sure. Smoking increases the risk of serious respiratory infections and lung diseases. Similar, although weaker, associations have been identified with e-cigarettes.
“Any time you inhale something into your lungs, whether through vaping, smoking or through occupational exposures, there is a risk of lung damage,” Keller said.
But most cases of vaping-related illnesses do not require a lung transplant, he added. A 17-year-old boy from Michigan who received a transplant in 2019 is believed to be the first case.
Regardless of the cause of his illness, Bauer said he no longer likes vaping.
“I thought it would be a safer alternative” to cigarettes, he said. “In retrospect, it seems like I should have quit sooner.”