An innovative surgical procedure combining breast implants and an artificial lung may help more patients with severe lung disease survive to receive transplants. The case was described in a press conference sponsored by Northwestern University, Evanston, Illinois.
In May 2023, a surgical team at Northwestern removed both infected lungs from David “Davey” Bauer, aged 34 years, and temporarily used double D breast implants to hold his heart in place until new lungs were available.
David Bauer’s new lungs (left) and old lungs (right).
In April 2023, Bauer, a longtime smoker and vaper, experienced shortness of breath. His girlfriend, Susan Gore, took him to an urgent care center, and he returned home, but “the next morning he couldn’t walk,” Gore said in the press conference. A trip to the emergency department yielded a diagnosis of influenza A, followed rapidly by a bacterial lung infection that proved resistant to antibiotics. Bauer had no prior medical history of serious illness, but he was soon in an intensive care unit (ICU). His condition continued to decline, and a double lung transplant was his only option.
The Northwestern Medicine Canning Thoracic Institute specializes in challenging cases, and Bauer was transferred there.
Back From the Brink
Bauer made the transfer to Chicago despite being critically ill. He was in dire need of a lung transplant, and the only way to resolve his infection was to remove the lungs, said Ankit Bharat, MD, chief of thoracic surgery and director of Northwestern Medicine Canning Thoracic Institute, in the press conference.
David Bauer post-transplant with Dr Ankit Bharat.
“Something needed to be done right away,” Bharat said. Bauer’s lungs were removed and the chest cavity was extensively debrided to remove the infection.
Then it was time for outside-the-box thinking. “With the lungs taken out, we needed something to support the heart,” he said. Breast implants came to mind, and double Ds were the largest available, he added.
In addition, the surgeons created an artificial lung system of conduits to keep Bauer’s blood pumping. “We wanted to maintain the natural blood flow in the body that would be present if the lungs were there,” Bharat explained.
Plastic surgeons at Northwestern gave Bauer’s surgical team “a crash course” in managing the breast implants, Bharat said. The team anticipated that their novel surgical solution would need to last for weeks, but Bauer’s condition improved immediately once the infected lungs were removed. He was placed on a double-lung transplant list, and the team received an offer of new lungs within 24 hours.
The breast implants were removed, the new lungs were implanted, and Bauer spent several months in the ICU before his discharge to rehabilitation therapy at the end of September, according to a Northwestern press release.
This type of procedure could help patients with infections who need transplants but are too sick to undergo them, Bharat said in the press conference. In Bauer’s case, “a lot of stars aligned,” including Bauer’s rapid improvement and the quick availability of a perfect lung match, Bharat said. Many patients don’t survive to the point of transplant, he added. “We were surprised how quickly he recovered once we removed the infected lungs,” Bharat noted. The quick recovery may be in part because of Bauer’s youth and relative good health, but “this was uncharted territory.”
Bauer’s case is the first use of this particular surgical technique, although the team drew on lessons learned in other surgical settings, such as removal of both lungs to prevent cross-contamination in patients with cancer, he added.
Causes and Effects
As for the factors that contributed to Bauer’s initial infection, “there is a lot we don’t know, but we can try to put things together,” said Bharat. Just as many factors lined up to promote Bauer’s recovery, many factors lined up to cause the problem, including long-standing smoking and vaping. Although some still view vaping as a safer alternative to smoking, patient data and experiences do not support this claim. “We know for a fact that both of them cause harm,” he said.
Bauer started smoking cigarettes at age 21 and typically smoked a pack of cigarettes each day before switching to vaping in 2014. In addition, Bauer had not been vaccinated against the flu, and his flu infection was followed by a bacterial infection.
Bacterial infections followed by hospitalizations are not new as an effect of vaping; a Medscape series described the ongoing epidemic of e-cigarette or vaping product use–associated lung injury (EVALI). Patients with EVALI often present at urgent care centers, as Bauer did, with symptoms of flu or pneumonia, and they are often given medication and sent home.
Looking ahead, “We expect that Davey will fully recover and live a normal life,” although he will remain in Chicago for another year for monitoring, said Rade Tomic, MD, pulmonologist and medical director of the Northwestern Medicine Canning Thoracic Institute Lung Transplant Program, in the press conference.
Bauer expressed his thanks to the surgical team, who also presented him with another gift: a T-shirt with his newly chosen nickname, “DD Davey.” “I feel so blessed, I got a second chance at life,” Bauer said in the press conference. He added, “you should not inhale anything into your lungs except oxygen.”
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