The situation of Francesco, whose lungs literally collapse, plummeted on 23 March and at that point the doctors of San Raffaele decided to connect it to Ecmo, a machine that is used for extracorporeal circulation and which increases the oxygenation of the blood by reducing blood values of carbon dioxide and increasing cardiac output and acting on body temperature. But even this action is not enough and it is only in mid-April that there is hope for Francesco. The experts of Thoracic Surgery and Lung Transplantation of the Polyclinic of Milan, directed by Mario Nosotti, decide one last desperate move: to give him new lungs. Except that the operation is completely new in our country, attempts have been made in China and Vienna.
«In addition to the technical skills, I must underline the stubbornness and courage of the San Raffaele colleagues who, instead of surrendering, have involved us in a solution never attempted before in the western world. Our experience is inspired by that of Professor Jing-Yu Chen of the Wuxi hospital in China, whom we personally know and with whom we discussed some technical aspects, since for obvious reasons he found himself facing the problem before us » , says Professor Nosotti, director of the School of Specialization in Thoracic Surgery at the University of Milan.
Given the situation of the Lombard hospitals in the midst of the coronavirus pandemic, it is not easy to prepare a similar intervention but despite this Francesco is placed on the list for transplantation on April 30th. The search for new lungs starts in Rome and in a few days there is an available donor who is not suitable. “But the boy had reservations about to end,” says Nosotti. In two weeks, then, the turning point: a suitable organ is identified, donated by a deceased person in another region and negative to the coronavirus, and the collection and transport of the lungs to Milan is immediately arranged.
“In the meantime – continues Nosotti – the colleagues of San Raffaele faced the delicate phase of transporting the patient to our operating room dedicated to Covid operations”. The transplant – done last week – during the coronavirus epidemic is even more complicated than usual, due to the protective devices and the use of ventilated helmets that make movement difficult. In fact, doctors think of a “change of surgical team, as well as anesthesiological and nursing team at regular intervals in order to allow colleagues to catch their breath”.
However, Francesco’s was not a simple intervention. «The lungs, in fact, appeared wooden, extremely heavy and in some areas completely destroyed. A widespread damage to the pulmonary alveoli, now unable to perform their function, with notes of extensive septal fibrosis was confirmed under microscopic examination “, explains Nosotti, who completes the operation and, after twelve hours, disconnects the ventilation extracorporeal: “Something not entirely common, especially considering that the patient had been connected to Ecmo for two months”. Hyperimmune plasma was also used in the delicate post-operative management.
«Our hospital is one of the most important centers in Italy for transplantation activities, both in terms of volumes and capacity for innovation. In 2019 we performed 34 lung transplants, we were the first to implement lung reconditioning in 2011, and the first donation to a non-beating heart donor in 2014. Since the beginning of 2020 we have already performed 9 transplants, including 4 during the pandemic -, explains Ezio Belleri, general director of the Polyclinic of Milan. He adds – We believe it is very important to spread our experience, confident that it can serve as a guide and inspiration for the many cases that the pandemic has generated. Being able to remedy lung damage from Covid19 with transplantation represents an additional opportunity for the many patients who have been hit hard by this coronavirus: it is not an easy path, but we have just shown that it can be successfully completed “.