And though the owner of that tiny heart cannot articulate concern or worry if their organ isn’t working properly, there’s plenty of anxiety expressed by a mom and a dad and grandparents and siblings. A baby with a bad heart can fill a room with dreadful silence.

That baby’s loved ones are looking to Dr. Bret Mettler for answers, for solutions, for reassurances. And that’s what they hear when listening to the empathetic tone and soothing cadence in his voice.

That characteristic – a physician with a sensitive bedside manner – accompanies Mettler’s significant skills as a pediatric cardiac surgeon. “I like fine detail and working in small spaces,” Mettler explained. “The highly technical aspect and sophistication of what I do is very interesting and satisfying for me. I also find it satisfying to inform and support families during such a stressful time in their lives. I’d say I found the perfect job.”

Mettler, a self-professed “simple kid” from Yankton, South Dakota, and a 2000 graduate of USD’s medical school, was a science nerd and athlete growing up. His primary high school sport was running long distances, and he contributed to state championship cross country teams at Yankton High School. He also learned the values of hard work and serving as a reliable teammate while in Yankton.

“I’m 100% certain that your experiences shape who you become,” Mettler declared. “I’m proud of where I grew up and where I went to college and medical school. Those experiences created strengths in me that continue to benefit me in my work and my life.”

Mettler contemplated medical school at a young age, and that interest escalated when he witnessed his determined mother return to college to become a speech pathologist after many years raising a family. “She wanted to help people,” remembered Mettler. “Her desire to make a difference in people’s lives was something that impacted and influenced me.”

While in medical school Mettler discovered an affinity for surgery. “I was drawn to the field because I like to take things apart and put them together again,” he said. “I also like to confront critical situations. I liked the personality of surgeons.”

After graduating from medical school, Mettler completed a residency in general surgery at the University of Texas Health Science Center in San Antonio and the University of Michigan. He furthered his training by completing a research fellowship in cardiac tissue engineering at Boston Children’s Hospital, followed by a cardiothoracic surgical residency at the University of Virginia’s School of Medicine. He pursued even more training through a congenital cardiac surgery fellowship at Boston Children’s Hospital, Harvard Medical School.

For 10 years, starting in 2010, Mettler directed pediatric cardiac transplantation at Vanderbilt University Medical Center, in Nashville, Tennessee. He and his team replaced defective hearts inside young people ranging in age from infancy to 18. “I did about 25 of those procedures each year while I was at Vanderbilt,” said Mettler. “Sixty percent of my patients were less than one year old.” He also served as an assistant professor of cardiac surgery at Vanderbilt’s children’s hospital.

Mettler had entered and found success in a field – pediatric cardiology surgery – that is relatively young and selectively small. “There are only about 120 of us in the entire country,” he described. “It’s a rare specialty, and those of us in it are highly collaborative.” Mettler explained that the idea of pediatric heart care started at Johns Hopkins Medical Center in the 1940s when surgeries to address health problems associated with blue babies were developed.

That historic association to his chosen field loomed large when Mettler considered an opportunity to join the Johns Hopkins Children’s Center, and in early 2020 he became that institution’s director of pediatric cardiac surgery, co-director of the Blalock-Taussig- Thomas Pediatric and Congenital Heart Center as well as an associate professor of surgery. His love of being a teammate had come full circle, as he assumed a leadership role and was able to assemble a collective of collaborative doctors, nurses and researchers to improve care for young cardiac patients and their families who travel from near and far for Hopkins’ famed expertise.

In addition to his work as a surgeon, Mettler is deeply involved in meaningful research, contributing to efforts aimed at preventing congenital heart disease and developing better heart monitoring systems. He is especially interested in developing an artificial pulmonary valve using a patient’s stem cells. Such a valve would grow as a child ages and its installation would eliminate subsequent replacement surgeries now necessary because today’s bioprosthetic valves or valves transplanted from donors do not change with age.

“Scientific investigation and research are a foundation of Johns Hopkins,” explained Mettler. “There are world-class experts at Hopkins in just about everything related to medicine.”

His days require the same type of endurance he developed as a competitive and successful cross-country harrier, with each day in his medical life beginning early and continuing until evening. His surgeries are not only complex, but lengthy. “Most operations I do last between eight and 20 hours,” said Mettler, remembering one procedure on a baby that spanned 43 hours. “I perform surgery just about every day,” Mettler declared. “Every day is different and challenging.”

The tensions of his work are part of what draws him to it. “I like the high-risk nature of cardiac surgery,” Mettler said. “The opportunity to fix something like a heart in a baby and give that patient 80 or 90 years of life is powerfully gratifying.” The data reveals that Mettler and his colleagues performing pediatric cardiac surgeries are highly accomplished. “About 98% of the procedures we do are successful,” he explained, “but that 2% mortality rate weighs heavy.”

Mettler and his wife, Kelly, have two daughters, Harper, 10 years old, and McCall, 8. “The critical aspects of my surgical work appeal to me and also remind me of the importance of family,” he said. “Performing these procedures provides profound gratefulness, but as we have started our own family, my feelings about my patients and their families have intensified.”

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