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need a vehicle to do it." Thanks mostly to private funds, Heart Care International provides that vehicle. The organization has directly helped close to 700 children in Guatemala, the Dominican Republic, and El Salvador. And many hundreds or even thousands more have benefited indirectly, because the visiting specialists also train local medical staff in how to better diagnose and treat heart disease.

"There's no shortage of intellect anywhere in the world, whether it's a developed country or a developing country," says Michler. "There are talented, smart, engaging, and gifted people [everywhere]. Our role is to really give those people the confidence to do [themselves] what we do on an everyday basis."

Many of the children helped by Heart Care International have told Michler they want to be a nurse or a doctor. Michler himself was only 10 when he first dreamed of being a heart surgeon. It was 1967—the year of the world's first heart transplant, performed by Christiaan Barnard in South Africa. "From that year forward," he recalls, "I knew I wanted to be a heart surgeon."

Perhaps that early commitment to the field is why his education, training, and career have followed such a smooth trajectory. After earning his undergraduate degree at Harvard in 1978, Michler came straight to Dartmouth and received his M.D. in 1981. He trained for nine years in general and cardiothoracic surgery at Columbia-Presbyterian Medical Center in New York. He then served as chief resident in cardiothoracic surgery there, and as chief resident in pediatric cardiothoracic surgery at Boston Children's Hospital.

From 1990 to 1997, he was on the faculty at Columbia and directed both the cardiac transplantation program and the cardiac transplantation research laboratory. In 1997, he became the chief of cardiothoracic surgery and thoracic transplantation at Ohio State University Medical Center, and in 2000 the executive director of Ohio's new heart hospital. With the same intensity that "I learned the field of heart surgery," explains Michler, "I learned the business of running a hospital, the life of philanthropy, the importance of development, the

Grew up: San Diego, Calif.
Education: Harvard University '78 and Dartmouth Medical School '81
Training: Columbia-Presbyterian Medical Center and Boston Children's Hospital
Estimated number of heart operations he's done: Over 5,000
Most unusual award he's received: The Order of Christopher Columbus, presented to him in 2003 by the president of the Dominican Republic for his humanitarian work
Media coverage of his work (besides this profile): Life, Time, New York Times, New York Times Magazine, and ABC World News Tonight

The monitor displays the delicate movements of Michler's scalpel as he cuts away thickened muscle.

importance of seeing medicine in a big picture, how it impacts society as a whole, what our responsibilities are—not just as physicians but as institutions, how we translate health care to make it effective and to make it available to everyone."

Then in 2005, Michler returned to New York and assumed his current position. At Montefiore, he chairs cardiothoracic surgery and codirects the Montefiore-Einstein Heart Center (which unites his department with the cardiology department). He also leads several research projects, chairs the surgical therapy committee, and serves as a local principal investigator for a trial called Surgical Treatments for Ischemic Heart Failure (STICH), which includes 90 medical centers in more than 15 countries. The STICH trial is trying to determine the best treatment for patients with heart failure and coronary heart disease. "Is it just maximum medical drugs? Is it bypass surgery? And if the heart is dilated, should it be reshaped?" Michler says those are among the questions being asked by STICH. The answers may "change the way we treat patients with heart disease in this country and around the world."

Michler is also excited about stem cell research as it relates to heart disease. For example, throughout the U.S., numerous early clinical trials are under

way using stem cells from bone marrow and other parts of the body to try to regenerate coronary vessels and muscle tissue. He and his colleagues at Montefiore are contributing to this field, too, as well as pursuing a different avenue. They're studying whether stem cells that naturally exist in the heart can boost immune tolerance for heart transplant patients. This past fall, Michler's team extracted and grew stem cells from a dog's heart. After performing a heart transplant on the dog, they injected the stem cells into the new heart. The hope is that they will make the dog's immune system see the new heart as more "self-like" and prevent rejection. If the treatment proves safe and effective in animal models, Michler hopes to be able to test it in humans in a few years.

Surgeon. Administrator. Researcher. Nonprofit founder. Not to mention husband and father. Michler and his wife have three daughters—ages 19, 16, and 12. Balancing all these roles can be a challenge. "What I have learned over the years is that I have to schedule the time" for family, he admits. "If the kids have something going on, I block it off my schedule."

He has also engaged his family in his nonprofit work. His 16-yearold daughter, who dreams of being a pediatric cardiologist, has gone on three Heart Care International missions. She is even forming an organization herself to bring high school students to Latin America to help out in orphanages and hospitals.

Michler has inspired many other people, in addition to his daughter. In fact, several of his former trainees eagerly joined him at Montefiore, suggesting he's an effective and admired mentor, too.

During the operation on the man with heart disease and idiopathic hypertrophic subaortic stenosis, another surgeon stops by to observe a particularly tricky part of the procedure. He and the surgical fellow look on with intense concentration, asking Michler occasional questions about his techniques. "You do whatever works," Michler says at one point. "There's no magic." Beneath the operating table, his large, bare feet rest on a towel. It's what works.

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Jennifer Durgin is Dartmouth Medicine magazine's senior writer.

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