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Pulmonology & Lung Surgery — Baylor St. Luke's Medical Center

Innovative health care in Houston, Texas

Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, transplantation, and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world.

Our strong alliance with Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve. 

Baylor St. Luke’s Medical Center is also the first hospital in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times.

Over 100 ex vivo lung perfusion cases performed

Baylor St. Luke’s Medical Center’s Ex Vivo Lung Perfusion Program has performed 105 ex vivo lung perfusion (EVLP) cases since its inception in 2018 using the TransMedics Organ Care System Lung (OCS Lung) technology.

Gabriel Loor, M.D., surgical director of the Lung Transplant Program at Baylor St. Luke’s and director of lung transplantation at Baylor College of Medicine, led the first breathing lung transplantation using the OCS Lung machine in 2014 in the Midwest and the first in Texas in 2018. In fact, Dr. Loor is a pioneer in this space, having played a key role in FDA approval of the OCS Lung device.

The OCS Lung machine is designed to keep donor lungs functioning and “breathing” in human-like conditions from the time of the donor procurement all the way to the transplant surgery. The device maintains the organ in its own physiologic state with blood, oxygen, nutrients and a sophisticated monitoring system that continually assesses the organ as it travels from donor to the recipient.

Typically, lungs transported in a standard ice cooler are implanted within six hours. But at Baylor St. Luke’s, cases were performed with preservation times ranging from six hours to 18 hours. Another benefit offered by using the OCS Lung machine is surgeons can accept donor offers from anywhere in the continental US and better manage logistics so that complex recipient operations can occur in the day rather than in the middle of the night.

In addition to the OCS Lung machine, the transplant team is exploring other technologies for organ preservation such as the Lungguard (Paragonix), which cools the organ without the potentially harmful effects of ice.

Baylor St. Luke’s transplant team saves lives from across the globe.

Organ transplant patients who travel great distances for lifesaving care at Baylor St. Luke's Medical Center benefit from the highest level of critical care in Baylor St. Luke’s Lung Transplant Program, which has gained an international reputation for the treatment of advanced lung disease and transplant care.

Led by Dr. Puneet Garcha, Medical Director of Lung Transplantation at Baylor St. Luke’s and Associate Professor of Pulmonary Medicine at Baylor College of Medicine, and Dr. Gabriel Loor, Surgical Director of Lung Transplantation at Baylor St. Luke’s and Associate Professor of Surgery at Baylor College of Medicine, the program serves patients from around the US and other countries who are often denied by other providers because the cost of insurance is prohibitive, the patient has a poor prognosis, or other reasons.

One recent double lung transplant patient is a case in point. A 54-year-old man, a resident of Hawaii, had developed pneumonia, which progressed to respiratory failure that severely damaged both of his lungs. Hospitalized locally, he was intubated and on mechanical ventilation. The patient, who was previously in good health and had no major health issues, also experienced respiratory and kidney failure, infection, gastrointestinal bleeding, and physical deconditioning.

Baylor St. Luke’s accepted the patient after he was rejected by other hospitals. He was airlifted over the summer from Hawaii to Houston, where he spent a month in the care of Baylor’s ICU nursing staff and therapists before being prepped for a bilateral lung transplant.

“We were able to secure a donor lung pretty quickly, and his health improved dramatically soon after the procedure,” said Dr. Loor.

Three months after the double transplant, the patient continued his recuperation in Houston, where he received physical therapy and occupational therapy every week, and re-established living independently. His prognosis is good for a complete recovery, Dr. Loor added. This patient’s experience is just one of many stories that reflect the quality of the critical care at Baylor St. Luke's Lung Transplant Program.

New research shows the promise of biomarkers in early detection and treatment of primary graft dysfunction in lung transplant patients

The discovery and application of biomarkers have revolutionized the treatment of patients with lung cancer, heart failure, and myocardial ischemia. Yet it has not yet been applied to the care of patients in whom complications develop after a lung transplant. 

Recently, a team of researchers from Baylor College of Medicine and the Texas Heart Institute conducted one of the largest single-center studies of biomarkers in lung transplant patients experiencing primary graft dysfunction (PGD) to discover what biomarkers might aid in earlier detection and improved patient care and outcomes. 

PGD is the main cause of chronic illness and death for patients who undergo a lung transplant. There is no cure for PGD. While patients can be successfully treated with supportive care, that alone cannot prevent the potential for irreversible harm to the donor allograft or other end organs. 

Early detection of PGD could be improved, however, with the ability to accurately map its molecular signature and specific biomarkers.

The study sought to validate the utility of protein biomarkers for detecting the severity and duration of PGD. The researchers used the most updated PGD grading guidelines, a contemporary cohort of 40 lung transplant recipients, and novel statistical methods to aid in detecting a wide breadth of biomarkers.

Their findings suggest that unique inflammatory protein expression patterns may indicate the severity and duration of PGD. The clinical use and continued examination of these biomarkers may not only help detect PGD early on, but also predict its progression, provide insights for drug development, and establish better treatment benchmarks. 

The study was published in September 2022 in Nature.

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.

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

Gabriel Loor, MD, FACC

Ivan O Rosas, MD

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.

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.

Robert Taylor Ripley, MD

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:

  • Bronchoscopy
  • Cervical mediastinoscopy
  • Chest wall resection and reconstruction
  • Hyperthermic intraperitoneal chemoperfusion (HIPEC)
  • Sleeve lobectomy/lung resection
  • Lung-sparing approaches to malignant pleural effusions
  • Lung volume reduction surgery (LVRS)​
  • Pleurectomy and decortication​
  • Pneumonectomy​
  • Robotic general thoracic surgery​
  • Robotic sublobar resection (segmentectomy and wedge resections), including minimally invasive approaches
  • Robotic sublobar resection (segmentectomy and wedge resections), including minimally invasive approaches

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:

  • Abnormal chest X-rays/CTs
  • Asthma
  • COPD
  • Endobronchial tumors and other airway obstructions
  • Hemoptysis (coughing up blood)
  • Lung cancer
  • Pleural effusion (fluid around the lungs)
  • Pneumothorax
  • Pulmonary alveolar proteinosis
  • Pulmonary nodule management
  • Tracheal stenosis

Procedures we offer include bronchoscopy as well as advanced procedures:

Advanced Diagnostic Bronchoscopy

  • Electromagnetic navigation bronchoscopy
  • Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration
  • Radial endobronchial ultrasound
  • Transbronchial cryobiopsy

Pleural Procedures

  • Pleural ultrasound
  • Pleurodesis
  • Thoracentesis
  • Tunneled indwelling pleural catheters

Therapeutic Bronchoscopy

  • Airway stenting
  • Balloon dilation of the airways
  • Bronchial thermoplasty
  • Bronchoscopic lung volume reduction
  • Electrocautery/electrosurgery
  • Endobronchial cryotherapy
  • Foreign body removal
  • Intrabronchial and endobronchial valves for persistent air leaks
  • LASER and argon plasma coagulation
  • Rigid bronchoscopy
  • Whole lung lavage

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.

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.

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.