Pulmonology & Lung Surgery

The pulmonary team at Baylor St. Luke’s Medical Center are experts in the management of a wide spectrum of lung conditions with a focus on advanced lung disease. At the forefront of research and innovation, and combined with our excellence in clinical care and education, we offer our patients unique access to new diagnostic and therapeutic modalities. Our program was designated high performing in Chronic Obstructive Pulmonary Disease (COPD) by U.S. News and World Report in 2020.

Pulmonary thromboembolic disease

Our surgical teams recently launched a successful pulmonary endarterectomy program for the treatment of patients with advanced thromboembolic disease. Our multidisciplinary teams handle a variety of cases involving acute and chronic pulmonary embolisms that require surgery, catheter-based therapies, or extracorporeal membrane oxygenation. Dr. Ajith Nair leads our pulmonary hypertension program and specializes in the care of patients with primary and secondary pulmonary hypertension from a variety of causes ranging from congenital heart disease to sarcoidosis.

BCM renames Thoracic Division in honor of late founder

Dr. David J. Sugarbaker, a pioneer in the field of thoracic surgery and an expert in the treatment of mesothelioma, founded the Baylor College of Medicine (BCM) Division of Thoracic Surgery’s The Lung Institute in 2014. It was the first multi-specialty lung institute in the state of Texas focused on the treatment of lung disease. Dr. Sugarbaker passed away in 2018, but his vision to build clinical, research, and training programs of global impact continues on. In honor of Dr. Sugarbaker’s legacy, our division will be renamed this year as the BCM David J. Sugarbaker Division of Thoracic Surgery.

Thoracic surgery

The Baylor College of Medicine Thoracic Surgery team has the ability to treat the full spectrum of thoracic issues, including expertise in lung preservation techniques, segmentectomy, and complex lung reconstructions. The team at Baylor St. Luke’s Medical Center began offering robotic thoracic surgery in 2017 and has since performed over 1,000 robotic procedures, including robotic general thoracic surgery and robotic subloar resection. In addition to their clinical work, the thoracic surgery team also has several ongoing clinical trials.

New grants support research of immunotherapy in thoracic cancers

Three surgeons at the Baylor College of Medicine (BCM) Division of Thoracic Surgery have secured research grants from the National Institutes of Health to study mechanisms of immunotherapy and carcinogenesis in malignant pleural mesothelioma and non-small cell lung cancer. Dr. Bryan M. Burt and Dr. R. Taylor Ripley are two of the grant recipients studying the two forms of lung cancer. Additionally, Dr. Hyun-Sung Lee, Director of the Division’s Systems Onco-Immunology Laboratory, was awarded an industry-sponsored $1.94M research grant to investigate and study the role of the anti-MIC (MHC Class I Chain-Related Protein) antibody in overcoming resistance to checkpoint immunotherapy.

Bryan M. Burt, MD, FACS
Professor and Chief, Division of General Thoracic Surgery Department of Surgery Program Director, General Thoracic Surgery Fellowship Baylor College of Medicine Director, General Thoracic Surgery Research Baylor College of Medicine
Robert Taylor Ripley, MD
Associate Professor of Surgery Division of General Thoracic Surgery Baylor College of Medicine Director, Mesothelioma Treatment Center Baylor St. Luke’s Medical Center Co-Editor Seminars in Thoracic and Cardiovascular Surgery Co-Director, Thoracic Oncology Working Group Dan L Duncan Comprehensive Cancer Center Member Baylor College of Medicine Dan L Duncan Comprehensive Cancer Center
Hyun-Sung Lee, MD, PhD
Assistant Professor of Surgery Surgery Thoracic Surgery Baylor College of Medicine Director Systems Onco-Immunology Lab Member Dan L Duncan Comprehensive Cancer Center

New portable device extends viability of donor lungs for transplantation

A portable device that mimics the human body may be able to extend the viability of donor lungs and make more of them available to patients needing a lung transplant.

Currently, about 80% of donor lungs cannot be used for transplants due to extended criteria, such as the donor’s age, the donor’s blood gases being too low, or that the lungs were donated after cardiac death or deprived of oxygen for more than six hours. With only a fraction of all lung donations meeting standard criteria for transplantation, up to 30% of patients die for lack of a viable organ.

But, thanks to research led by principal investigator Dr. Gabriel Loor, director of lung transplantation at Baylor’s Michael E. DeBakey Department of Surgery, the portable device, called the TransMedics Organ Care System, or the breathing lung device, was found to keep lungs from donors in the extended criteria category healthy and viable for transplantation.

The portable device houses the donor lung and works by pumping blood through the organ, maintaining a normal body temperature, and providing proper ventilation and continuous monitoring of the organ’s quality during its transportation from storage to the operating room.

In a 2019 trial of 79 transplants using lungs from extended criteria donors that were housed in the breathing lung device, 91% of patients were still alive one year after the transplant, which is even higher than the expected outcome for a standard lung transplant.

As a result of this multicenter, international trial and a previous study, the TransMedics Organ Care System received FDA approval for standard donor lung transplantation as well as extended criteria lung transplantation.

Researchers are optimistic that the use of the device has the potential to make about half of the 80% of unutilized donor lungs viable for transplantation.

“This opens the door to providing this life-saving intervention to many more patients now than we have before,” said Dr. Loor, who noted that the technology is still new and needs further testing and that gene therapy, stem cell, and pharmacology options should continue being explored to make even more donor lungs viable and available to people who need them.
Puneet Singh Garcha, MD
Medical Director
Lung Transplant Program
Baylor St. Luke’s Medical Center
Associate Professor
Medicine – Pulmonary
Baylor College of Medicine
Gabriel Loor, MD, FACC
Associate Professor of Surgery
Cardiothoracic Transplant and Circulatory Support
Baylor College of Medicine
Co-Chief, Section of Adult Cardiac Surgery
Baylor St. Luke’s Medical Center
Surgical Director, Lung Transplant Program
Baylor St. Luke’s Medical Center
Ivan O Rosas, MD
Professor and Section Chief
Department of Medicine
Pulmonary, Critical Care and Sleep Medicine
Baylor College of Medicine
Lester and Sue Smith Chair in Lung Health
Baylor College of Medicine

Giving people with irreversible lung disease a new lease on life

As a premier referral center in the U.S. for complex, end-stage lung diseases, the Baylor St. Luke’s Medical Center (BSLMC) Lung Transplant Program comprises an experienced, collaborative team of transplant pulmonologists, cardiothoracic surgeons, and cardiothoracic ICU staff who are leading the way for patients needing a lung transplant. Having performed 70 transplants in 2021, as well as multi-organ transplants (heart-lung, lung-liver, lung-liver-kidney), and transplants in patients with prior serious challenges such as cardiac surgery, previous heart or lung transplants, or multiple organ failure. We have also performed 12 transplants for COVID ARDS with 100% survival.
We are also the nation’s leading center for portable normothermic ex vivo lung perfusion using the Organ Care System Lung (OCS Lung). Better known as a “Lung-in-a-Box,” this revolutionary system, which was approved by the FDA in 2021, mimics the human body to better preserve the viability and longevity of donor organs for transplantation. It’s one more reason why our patients who need a lung transplant experience shorter wait times compared to the regional and national average.

In another first in Texas, the Baylor College of Medicine (BCM) Lung Institute and critical care teams at BSLMC were the first in our state to support patients with advanced lung disease with the Abiomed Breethe System. This portable ECMO unit is the smallest of its kind approved by the FDA for use in the U.S. in a limited registry of expert users, and it offers hope for durable therapy in patients who need ECMO support in order to breathe.

The BCM Lung Institute also hosted the recent Annual Thoracon Advanced Lung Disease Conference, which provides engaging, state-of-the-art multidisciplinary lectures focused on the causes, diagnosis, prevention, and treatment of diseases affecting the lungs. Held virtually, the two-day webcast, co-directed by Dr. Puneet Garcha, Dr. Gabriel Loor, Dr. Prasad Manian, and Dr. Ivan O Rosas, featured guest speakers from around the country and attracted an international audience.

Our program will continue to grow. By spring of 2022, we will provide accessible advanced lung disease care in an outreach clinic at St. Luke’s Health–The Woodlands Hospital. To help improve patients’ physical conditioning both pre- and post-transplant, we will also offer an online rehabilitation program run by our exercise physiologists. We have established a transplant biorepository, databases to investigate chronic lung allograft dysfunction, and novel non-invasive tests to detect rejection of the lung allograft.
We are also involved in collaborative research with institutions both in the U.S. and worldwide. Our research teams are investigating methods to improve outcomes using ex vivo lung perfusion, biomarkers, and exosome therapies. We are also active investigators in several leading clinical trials, including a recent validation of the updated ISHLT scoring system for primary graft dysfunction (PGD), a consensus document on PGD scoring, an international assessment of OCS Lung, and an analysis of gender differences in the evolution of primary graft dysfunction.

Baylor develops programs for COVID-19 patients and long-haulers

In response to a high number of patients experiencing COVID-19 in the Houston area, Baylor St. Luke’s and Baylor College of Medicine developed an at-home telehealth program for people with mild symptoms. Through this project, our doctors can monitor and treat COVID-19 patients at home.
Additionally, people who have had COVID-19 and recovered from the virus are at an increased risk of developing other serious health issues in the future. Long-haul COVID-19, or the after-effects of COVID-19, can include life-threatening conditions such as pulmonary fibrosis, heart failure, renal failure or blood clots, and pulmonary embolism.
To help people experiencing the lingering symptoms or new side effects after having COVID-19, Baylor College of Medicine has opened a Post-COVID Care Clinic at the Baylor St. Luke’s Medical Center – McNair Campus to offer patients a dedicated, multidisciplinary approach to their care that will help them on the path to recovery.
The clinic provides comprehensive, personalized care that focuses on each patient’s experience. People with long COVID-19, also known as long-haulers, often have symptoms such as fatigue, shortness of breath, and a loss of smell and taste that are continuations of the initial infection. Some never experience major symptoms while having the virus but can develop new symptoms after recovery.
We recommend in-person exams where clinicians can perform a thorough assessment to determine what impacts the new side effects or persistent symptoms might have on specific organs. Long-term symptoms of COVID-19 can affect several organ systems in the body; the most concerning are those that affect the lungs, heart, and brain. Patients fill out a questionnaire that assesses how COVID-19 has affected them, which is followed by an evaluation by a pulmonary specialist who will then provide a management plan personalized to each case. This care plan may include pulmonary, cardiovascular, neurological, and PMR services, all of which they can access at Baylor St. Luke’s.
Beyond providing care to patients, we also have an active COVID-19 research program. Our doctors are looking at this virus from a variety of angles. We’re currently:

Continuing to specialize in mesothelioma treatment

The late Dr. David Sugarbaker, a pioneer in advancing the treatment of pleural mesothelioma, founded the Mesothelioma Treatment Center (MTC) and recruited Dr. R. Taylor Ripley, who now serves as the Director. With only a handful of centers treating mesothelioma regularly in the U.S., the MTC has one of the busiest programs; last year alone, the center saw over 100 patients.
With access to leaders in the field of mesothelioma care and treatment, unparalleled resources and collaborations, and rapid access to care, Baylor St. Luke’s offers advanced therapies not available anywhere else in the world.
With a multidisciplinary patient approach, the center is comprised of social workers, nutritionists, chaplains, exercise physiologists, and nurse practitioners, in addition to the expert surgical team. For patients who undergo surgery, offerings include an Extended Pleurectomy and Decortication (ePD), sparing the lung and avoiding a pneumonectomy.

Clinical Trials at the Mesothelioma Treatment Center

Enrollment has also started for the NRG-LU006 (ClinicalTrials.gov: NCT04158141), in which patients will receive IMRT to the chest wall after ePD. Additionally, Baylor St. Luke’s participates in the IASLC Mesothelioma Staging Project as well as multiple translational trials.
Dr. Bryan Burt, Acting Chief of General Thoracic Surgery at Baylor College of Medicine, is principal investigator in a phase 2 clinical trial assessing the efficacy of nivolumab and intratumoral MTG201 as second-line therapy for pleural mesothelioma. MTG201, a replication-incompetent adenovirus, was developed by Momotaro-Gene Inc. in Japan. MTG201 accelerates tumor cell apoptosis, allowing the immune system the opportunity to recognize antigens that were previously invisible extracellularly.
“This, we believe, may be one mechanism that provides the immunotherapy with an opportunity to be more effective,” according to Dr. Burt. Currently, the Baylor College of Medicine Lung Institute is the only center testing this treatment combination. The study includes patients with any stage of pleural mesothelioma who have seen growth or recurrence despite previous treatment with chemotherapy or surgery.

"When someone is diagnosed with metastatic disease, for example, we send a sample of the cells, or a biopsy, for genetic testing. If we find there are certain mutations present, we are able to tailor the treatment with drugs that target those mutations. The results of this type of tailored treatment have been remarkable and represent a giant leap forward in lung cancer care."

Bryan Burt, MD, FACS
Thoracic Surgical Oncologist, Baylor St. Luke’s Medical Center Director of General Thoracic Surgery Research, Baylor College of Medicine
Robert Taylor Ripley, MD
Director, Mesothelioma Treatment Center Baylor St. Luke’s Medical Center
Bryan Burt, MD
Director of General Thoracic Surgery Research at Baylor College of Medicine

State-of-the-art thoracic surgical care

Baylor St. Luke’s Medical Center, the clinical home for Baylor College of Medicine, leads in the advancement of multiple areas of thoracic surgery, from mesothelioma and lung cancer surgical techniques to employing new methods in treating advanced COPD.
Our robust training program in thoracic surgery has dedicated physicians for non-cardiac thoracic surgery — one of the only programs in Houston, the nation’s fourth-largest city. Because we understand how specialized thoracic surgical care should be, the Lung Institute has a dedicated thoracic surgery ICU space, led by a highly knowledgeable team.
Our comprehensive thoracic surgery clinic is a funded project by the Cancer Prevention & Research Institute of Texas. All of the Institute’s attendings are active in research, education, and clinical care as Baylor College of Medicine staff and members of a Multidisciplinary Tumor Board.
Baylor Medicine is the only center in Texas approved by CMS to perform lung volume reduction surgery (LVRS). We also offer bronchoscopic lung volume reduction (BLVR) as a potential alternative to LVRS and a less invasive method to achieve lung volume reduction in patients with emphysema and hyperinflation.
Baylor Medicine has the ability to treat the full spectrum of thoracic issues, including expertise in lung preservation techniques, segmentectomy, and complex lung reconstructions. At the forefront of innovation, the team at Baylor St. Luke’s Medical Center began offering robotic thoracic surgery in 2017 and has since performed over 500 robotic procedures.
Our capabilities include:

Board-certified interventional pulmonologists

In collaboration with Baylor Medicine, Baylor St. Luke’s Medical Center employs board-certified interventional pulmonologists, making us one of the largest lung centers in Texas that provides interventional pulmonology. As part of our comprehensive lung program, our physicians perform advanced diagnostic bronchoscopy, pleural procedures, and therapeutic bronchoscopy.

Our Interventional Pulmonology Program offers consultation services for both malignant and benign disorders of the lung and the airways. Led by Dr. Ali Jiwani, this program offers a multidisciplinary approach to evaluation and management.

Conditions treated by our interventional pulmonologists include:

Procedures we offer include bronchoscopy as well as advanced procedures:

Advanced Diagnostic Bronchoscopy
Pleural Procedures
Therapeutic Bronchoscopy

Pioneers in sleep apnea treatment

The Baylor St. Luke’s Center for Sleep Medicine is led by Dr. Fidaa Shaib, Medical Director and pulmonologist.
Accredited by the American Academy of Sleep Medicine, our program utilizes state-of-the-art technologies in the diagnosis and treatment of sleep disorders. Our team of experts collaborates with a multidisciplinary group of specialists for the treatment of sleep apnea, narcolepsy, and other sleep disorders.
Our services also include non-pharmacologic options for the management of insomnia and other sleep disorders with cognitive behavioral therapy. Our clinicians also provide care for patients with advanced neuromuscular disease who need respiratory support.
We offer alternative options to traditional forms of therapy for sleep apnea, including upper airway stimulation and dental appliances. Our center is the only site for Upper Airway Stimulation therapy for OSA in the Texas Medical Center.

Upper Airway Stimulation Therapy

Dr. Andrew Huang, an otolaryngologist at Baylor St. Luke’s Medical Center, is the first surgeon in the Texas Medical Center to implant a novel device to treat patients with obstructive sleep apnea (OSA).
The Inspire device is the first FDA-approved tool to treat the root of OSA by providing mild stimulation to open the airway while patients are asleep. It has been shown to significantly improve OSA and is a particularly viable treatment option for patients who don’t tolerate CPAP therapy.
“There haven’t been any providers in our region that can administer this, follow it, and do it at a high level, so we’re proud to offer that to the Houston population,” said Huang. “It has been an unmet need for our sleep apnea patients in Houston as it is an extraordinary tool that has been shown to not only cure the problem but cure it long term.

Connecting the thoracic community

The Baylor College of Medicine Lung Institute recently hosted the annual THORACon: Advanced Lung Disease Conference, which was held virtually and featured guest speakers from around the country. We had an international audience, and CME credit was available for participants. The talks were recorded and are now hosted on the VuMedi Platform.

Patient Story

Chris's story: from stage four to survivor

Active and healthy his whole life, Chris Augustin was first misdiagnosed with exercise-induced asthma and then pneumonia. Years later, Chris discovered he had stage-four left thoracic and abdominal epithelioid mesothelioma. Because his mesothelioma had spread so deeply, his cardiothoracic surgeon did not feel comfortable operating and suggested chemotherapy prior to surgery to shrink the tumors.
Searching for further options, the family found Baylor Medicine’s Mesothelioma Treatment Center at Baylor St. Luke’s Medical Center. Dr. R. Taylor Ripley, the Director of the Mesothelioma Treatment Center, believed that chemotherapy prior to surgery would likely make him weaker. Instead, Dr. Ripley was willing to operate right away.
He performed the surgery in two parts. The first part removed the tumors in the pericardium and lungs. The second was scheduled with ample time for recovery and ultimately removed the remaining tumors in the abdomen. To finalize the treatment plan, Chris visits a local oncologist to continue with adjuvant chemotherapy. He also visits Dr. Ripley every three months for follow-up. But today, no evidence of the disease exists.

Cystic fibrosis and bronchiectasis clinics

One of the largest cystic fibrosis programs in the nation, the Maconda Brown O’Connor, Ph.D., Adult Cystic Fibrosis Center offers comprehensive, multidisciplinary care to patients with cystic fibrosis as well as access to clinical trials and new therapeutics.
A condition called bronchiectasis, in which the airways of the lungs become dilated (leading to chronic airway infection and inflammation), is a common finding in patients with cystic fibrosis. However, this condition can also occur independently of cystic fibrosis. A new clinic at Baylor Medicine is now offering evaluation and treatment for patients with non-cystic fibrosis bronchiectasis.
“Bronchiectasis obstructs airflow and can make it difficult to clear the airways,” said Dr. Tara Barto, pulmonologist at Baylor Medicine.
There are many causes of bronchiectasis; it can be related to severe reflux disease with aspiration (reflux of liquid into the lungs), rheumatologic conditions, immune deficiencies, or alpha-1-antitrypsin deficiency, to name a few examples. Approximately 30% of the time, there is no specific cause.
Symptoms include shortness of breath, fever, cough, mucus production, and chest pain. Oftentimes, these patients are diagnosed with recurrent or chronic bronchitis (occurring multiple times per year). The condition is definitively diagnosed by a CT scan of the chest. The mainstay of therapy focuses on airway clearance strategies and suppression of infection.

“Small changes to therapy can make big changes in the life of someone who is suffering from this,” said Barto.

She works with patients to customize a treatment plan to help manage the condition and prevent progression. Usually, she recommends a treatment therapy that patients must follow two times a day, which includes a combination of medications taken in a specific order to open the airways, thin out the secretion, and then clear the airways. Her clinic is unique in that it is multidisciplinary, with a dedicated respiratory therapist to provide education and assistance with inhaled therapies and airway clearance devices.

Additional programs

Interstitial Lung Disease (ILD)
This program is led by Dr. Ivan Rosas, Section Chief of Pulmonary, Critical Care, and Sleep Medicine. Dr. Rosas is a nationally recognized leader in ILD treatment and research. Our multidisciplinary team offers expert clinical care in addition to access to clinical trials and lung transplantation.
The Airway Disease Program
This is a collaborative program that involves the Pulmonary, Otolaryngology, and Allergy/Immunology teams. This program evaluates patients with severe asthma and end-stage COPD in addition to upper airway disorders.
This multidisciplinary team is led by Dr. Nicola Hanania, a world-renowned expert and researcher, alongside Dr. Donald Donovan (ENT) and Dr. Sanjiv Sur (asthma expert) and offers cutting-edge diagnostic and therapeutic interventions.
In 2019 alone, over 500 patients were seen in the Baylor Medicine Pulmonary Clinic.