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.

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
Patient Story

Patient Story: Kathleen Cruz With Interventional Pulmonologist Dr. Ali Jiwani

Kathleen worked in health administration for over 40 years. She recently retired, and in April 2019, she went to a local hospital (Conroe Regional) after a few days of not feeling well. When she presented to the hospital’s emergency room, they diagnosed Kathleen with the flu. But after admitting her, the doctors diagnosed her with double pneumonia and sepsis.
She was hospitalized for three months, during which time she was intubated and trached for weeks. She was discharged from the hospital in mid-June 2019 and was totally run down. She lost 30 lbs, was wheelchair-bound, and couldn’t feed herself.
The doctors recommended therapy, and she participated in outpatient rehab without much progress. A few days after she was discharged, she landed back at the local hospital. Her trachea collapsed, and due to the extent of her tracheal stenosis, none of the doctors at the hospital had any experience treating her condition. The only two centers able to provide the care she needed were UTMB Galveston and Baylor St. Luke’s Medical Center.
She chose to be transferred to Baylor St. Luke’s Medical Center. She was transferred at 10 a.m. and was out of the OR by 1 p.m. and stabilized. A few days later, Ms. Cruz was discharged from the hospital. Dr. Ali Jiwani advised that due to the extent of her tracheal stenosis, she might require a trach for life as well as routine bronchoscopies to keep her airway open.

Ms. Cruz went home requiring some support but was walking 4-5 weeks after the procedure, out of diapers, and on the road to recovery. She still had a trach and required oxygen and suction, but she was happy to be recovering. She continued to follow up with Dr. Jiwani regularly and had routine bronchoscopies to dilate her airway.

In October, she had a planned trip to Aruba with her family. Hesitant to go on a vacation with the medical equipment, Dr. Jiwani encouraged her to go on the vacation anyway.
In October, she had a planned trip to Aruba with her family. Hesitant to go on a vacation with the medical equipment, Dr. Jiwani encouraged her to go on the vacation anyway.
“He told me I needed it,” Cruz stated.
After her vacation, she returned to Baylor St. Luke’s in November 2019 for another bronchoscopy — this was her fourth one. In the recovery room after the procedure, she felt around her neck and realized that there was no longer a trach in place.
Photo of Kathleen Cruz and Dr. Ali Jiwani
“It was a miracle,” Cruz said.
When she realized her trach was removed, she broke down crying. Dr. Jiwani stated that most patients usually don’t have success keeping their airways open after about two bronchoscopies. In this case, Ms. Cruz defied all odds, and the airway stayed open.
What stuck out to her the most was that Dr. Jiwani himself transferred her from her recovery room after the last bronchoscopy and into her patient room.
“Dr. Jiwani is my miracle worker.”
Since her last bronchoscopy in November, Ms. Cruz has since sent all of her medical equipment back to the company.
“I can walk the mall,” she says. “I have my nails done, I ride a Harley Davidson, and I drive my Mazda Miata. Aside from a small scar from where the trach used to be, you would never guess I was ever sick.”
Ms. Cruz is even being considered for tracheal reconstruction surgery, which she was not previously a candidate for.

“Every day I wake up, it is a beautiful day thanks to Dr. Jiwani and the team at Baylor St. Luke’s Medical Center.”

Kathleen Cruz

Improving Outcomes in Lung Transplantation

The Lung Transplant Program at Baylor St. Luke’s Medical Center has been performing successful lung and heart-lung transplants since the 1990s, completing 46 lung transplants in 2019 alone. The team also utilizes ex-vivo lung perfusion (EVLP) to keep the transplant lungs in a physiologic state throughout transportation.
The organ care system (OCS) is the only portable EVLP system in the world and the only EVLP system that has undergone a positive FDA panel review in the United States as well as two rigorous international clinical trials.
Baylor St. Luke’s Medical Center was the first site in Texas to utilize the organ care system lung platform and the first site in the nation to begin the clinical trials to expand usage of the OCS Lung System. As a result of the trials, clinicians are now able to safely use organs that would have been rejected.
“Bridging the divide between a donor and a recipient has always been at the cornerstone of transplantation,” says Gabriel Loor, MD, Surgical Director of the Lung Transplant Program at Baylor St. Luke’s Medical Center and the International Principal Investigator for the largest study in the U.S. evaluating the ability to increase the number of usable donor lungs using the OCS technology.
Gabriel Loor, MD, FACC
Surgical Director, Lung Transplant Program
Baylor St. Luke’s Medical Center

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.
Patient Story

Chris’ 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.