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When 34-year-old Davey Bauer’s lungs failed, doctors turned to an unusual option to keep him alive: large breast implants.
Experts say this was an innovative solution to give Bauer’s body time to fight off the nasty infection and allow him to receive a life-saving double lung transplant.maybe This is the first example of a transplant practice that has the potential to save patients with infections who, just a few years ago, probably would not have survived.
For Bauer It started in April when I felt like I couldn’t breathe. The avid snowboarder and skateboarder has always been in good health. He stayed in good shape and maintained a healthy weight while working in a landscaping business in DeSoto, Missouri. However, he has been a smoker for a long time and at the age of 21 he started the habit of smoking a pack of cigarettes a day. In 2014, I switched to e-cigarettes.
“I thought it was a healthier option,” Bauer said. “But to be honest, I found it more addictive than cigarettes.”
people inhale smoke or vaporthe lung tissue may remain inflamed and the organ’s condition may worsen further. susceptible to For infections. Additionally, Bauer said she had not received a flu shot and it was still flu season.
“You have all these risk factors. Smoking and e-cigarettes compromise your lung health, and if you don’t get a flu shot, you get infections,” says Bauer, a thoracic surgeon and physician. said Dr. Ankit Bharat, director and director of the Cheating Chest Institute. Northwestern Medicine. “If everything goes well, you’re setting yourself up for a major disaster.”
Bauer continued to have trouble breathing, so he went to the doctor, where tests revealed he had the flu. Her breathing problems became so severe that she had to be admitted to a St. Louis hospital.he also developed Additional lung infections that did not clear up with antibiotics.
The damage to his lungs was so extensive that doctors put him on extracorporeal membrane oxygenation, or ECMO. tool It pumped Bauer’s blood from outside his body and oxygenated it. The device is designed to allow a patient’s lungs and heart to rest and heal, but in this case that wasn’t enough.
Doctors decided his only hope was a double lung transplant. They took Bauer to Northwestern Memorial Hospital in Chicago, where his condition worsened.
“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. Told.
It was a different kind of challenge than a typical lung transplant, he said. People who need transplants often have chronic conditions such as emphysema or cystic fibrosis that develop over time. Doctors can plan and patients can work on keeping themselves as healthy as possible and wait for a donor to become available. In that case, doctors would remove the damaged lung of the person who has the donor lung and immediately replace it. But that wasn’t the case with Bauer.
He was suffering from acute pulmonary failure. He didn’t have time to wait for a donor, but he was too unwell to undergo the transplant procedure.
“For people like David, who were on the verge of death and had a severe illness, there is generally no option for a transplant and they just die,” Bharat said. “We had to come up with a strategy to do something that had never been done before.”
Mr. Bharat has a history of successfully performing double lung transplants in people with severe infections. terminal cancer. In June 2020, he and Northwestern Medicine surgeons first known Double lung transplantation for patients infected with the novel coronavirus in the United States and patients survived And then he was discharged from the hospital. A similar approach can be used here.
However, the first challenge to be overcome was infectious disease.
“When I opened the chest, all I saw was something full of pus, yellow and smelly,” Bharat said. Surgeons carefully removed the lung to prevent the spread of bacteria and removed everything that appeared to contain the infection. They also kept Bauer on high doses of antibiotics.
They thought it would take weeks, but within days the infection seemed to be gone from his body.
“Miraculously he started getting really good and I thought we could transfer him,” Bharat said.
Another problem was how to keep blood flowing so Bauer’s body was ready to receive donor lungs while he waited for the infection to clear up.
The heart and lungs work together through two pumps in the heart that are attached to each other on the left and right sides. Blood flows from right to left through the lungs.
Bharat described it as like a highway going in one direction to the right, from the heart to the lungs, and another highway going back to the left. Inside the body, the organ returns blood to the right side of the heart and pumps blood to the lungs. The lungs take in oxygen and expel carbon dioxide. This highway system then pumps blood back to the left side of the heart, pumps blood to other parts of the body, pumps it back to the heart, and the cycle continues.
Removing a lung would destroy the highway system and remove the link between right and left. “It’s not a survivable situation,” Bharat said.
Doctors had to use part of the ECMO machine to create artificial channels for blood to flow around Bauer’s body.
“I spent all night thinking about how to create these channels and do all these things,” Bharat said.
The final challenge was what to do with the mind. Although it’s located in the center of the body and attached to multiple blood vessels, it’s “squishy,” Bharat said.
“When the patient turns, it can fall to one side or twist everything, so we had to create a mechanism to keep the heart centered,” Bharat said.
A lab sponge wasn’t big enough, he said, so he needed something that could be molded into the chest. That’s where breast implants come in. Double-D implant. Inside his chest cavity, he was able to temporarily keep his heart where it should be.
The entire process took only a few days. Doctors removed Bauer’s lungs on May 26, and a donor pair became available the next day. On May 28, surgeons removed the placeholder breast implant and inserted a donor lung.
The Northwestern University team told Bauer’s family that this was one of the most complex cases they had ever seen.
“He is well on his way to a full recovery, which is really amazing for us to see,” Bharat said.
Yoshiya Toyoda, M.D., chief of thoracic transplant surgery, cardiovascular surgery, and mechanical circulatory support at Temple University Hospital, said the procedure carries real risks, even greater than a typical lung transplant. It is related to the Bauer case.
A typical lung transplant involves a single surgery in which the lung is removed and the donated organ is transplanted. All surgeries carry significant risks, and Bauer required multiple surgeries. Using man-made systems to keep blood flowing also carries the risk of developing blood clots, which can cause strokes. “That’s another drawback to this approach,” Toyoda says. However, he added, “It was a success, so I want to congratulate it.”
By June, Bauer was already sitting up and breathing on his own for several hours at a time, according to the family’s Gofundme page. By mid-June, he was taken off his breathing machine and began breathing with his new lungs.
His recovery took several months in intensive care, but by late September he was discharged from the hospital and healthy enough to continue treatment at an out-of-hospital rehabilitation facility.
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Dr. Albert Rizzo, chief medical officer of the American Lung Association, said his successful recovery was remarkable and the techniques doctors used were innovative.
“I spoke to several transplant surgeons yesterday and they also feel this is revolutionary,” he said. “It seems like an ingenious way to solve the problem.”
Unfortunately, Bauer won’t be able to attend his beloved St. Louis Cardinals on Opening Day at Busch Stadium next spring. He must stay in Chicago for the next year so doctors at Northwestern University can closely monitor him.
Although his doctors have not yet been able to convert Bauer into a Chicago Cubs fan, he said he is receptive to their innovative efforts to save him.
He told doctors at Northwestern University that he planned to change his entire game profile and make T-shirts with his new nickname, “DD Davey.”
