Prince of Hearts

Dr. Michael Teodori holds the hearts of many Valley children - often literally - in his hands

But St. Joe's held -- and still holds, at least until the end of this year -- a $32 million contract with the state of Arizona to operate and manage the CRS program in Maricopa County. In September 2000, the hospital hired Dr. David Cleveland, formerly of Dallas, to fill the void left by Dr. Teodori's exit.

However, until Dr. Teodori's recent accident, several cardiologists had continued to refer the more complex CRS cases to him "out of network." For financial reasons, the state and St. Joseph's frown upon that practice, but it demonstrates the high regard in which other cardiologists hold Teodori.

This year alone, Teodori performed 12 heart surgeries on CRS patients at Phoenix Children's, including on Xzavion Gonzales, with several more scheduled before his car crash.

The morning of Xzavion's operation, June 3, 2002.
Paul Rubin
The morning of Xzavion's operation, June 3, 2002.
Dr. Michael Teodori (left) operates on Xzavion Gonzales, as Dr. Tom Waitz and nurse Amy Riccio assist. Inset: Dr. Teodori prepares to sew in Xzavion's new pulmonary valve.
Paul Rubin
Dr. Michael Teodori (left) operates on Xzavion Gonzales, as Dr. Tom Waitz and nurse Amy Riccio assist. Inset: Dr. Teodori prepares to sew in Xzavion's new pulmonary valve.

Since the accident, however, those same cardiologists have been referring many complex CRS heart cases to Dr. Cleveland of St. Joe's, not just to Teodori's new partner Dr. Lupinetti, who has just started to earn his stripes locally.

No one is yet sure how Teodori's injured status may affect the new CRS contract, which comes up for bid later this year. St. Joe's and Phoenix Children's are expected to compete for the lucrative contract.

The operating room at Phoenix Children's is cold enough to hang meat in. It's that way for two reasons: So Xzavion Gonzales will be kept cool during the operation, and because Dr. Teodori tends to perspire profusely while performing surgery.

Dr. Teodori downs a cup of hot chocolate in the cafeteria -- no caffeine before surgery -- as his team prepares for Xzavion's procedure. It includes anesthesiologist Dr. Casey Lenox and Dr. Tom Waitz, who will be first assistant to Teodori during surgery. Curtis King will be operating the crucial heart-lung bypass machinery, Amy Riccio will be the scrub nurse, and Rita Boese and Janet Moore will be the on-duty circulating nurses.

The music system Teodori bought for the operating room isn't hooked up yet. That means there will be none of the light jazz, classical or R&B music that the doctor favors while working.

Teodori enters the room at 9:17 a.m. He is wearing turquoise-blue surgical scrubs and cap. He attaches a coal-miner's-like light to his forehead, straps on his magnifying goggles, and gets to work.

Within minutes, he's cut through Xzavion's sternum with a high-powered electric saw. The nauseating smell of the boy's burning flesh wafts through the frigid room. He pulls Xzavion's ribs apart with a metal device, moves aside the thymus gland, and exposes the heart.

Shaped like an upside-down pear, it's beating like a drummer in a punk-rock band. Dr. Lenox soon thins Xzavion's blood before sending it to the bypass machine located a few feet from the operating tables.

The machine will keep the boy alive for much of the operation, as it circulates his blood through his body while his heart is stopped. But surgeons are keen to keep the time that a patient is on the bypass to a minimum, because it can mean potential damage to the brain, liver or kidneys.

"Bypass on," Curtis King says loudly at 10:07 a.m.

The doctors chill Xzavion's body to 63 degrees. Teodori then stops the boy's heart with a shot of potassium.

Teodori is about to start a Ross operation, a sophisticated procedure that only a few hundred heart surgeons have mastered worldwide. Named after the British doctor who developed the operation in the late 1960s, it calls for a surgeon to cut out the defective aortic valve, then move the patient's own healthy pulmonary valve to the aortic valve position. The surgeon then replaces the original pulmonary valve with a valve from a human donor. For various reasons, cadaver valves work far better as pulmonary valves than as aortic valves.

As recently as the 1980s, most doctors would have replaced Xzavion's bad aortic valve with one harvested from a pig, or may have installed a mechanical valve. But studies have shown that patients in Xzavion's shoes stand a far better chance at a normal life span after a successful Ross operation.

Two cadaver valves sit in a freezer in an adjacent room. The donor valves come from a 37-year-old woman who died of blunt-force trauma -- sounds like a homicide to the operating team -- and a 17-year-old girl who died in a car accident.

Within a few hours, Dr. Teodori will reinvent one of those valves as Xzavion Gonzales' new pulmonary valve. He and his team labor with quiet urgency, as nurse Rita Boese starts to thaw out the deceased 17-year-old's valve in hot water shortly before 11 a.m.

Dr. Teodori says he concluded in the late 1990s that the quality of St. Joe's pediatric intensive-care unit was far inferior to that of Phoenix Children's. To that end, he sent a remarkable letter in September 1999 to officials at Children's Rehabilitative Services, which had contracted with St. Joe's to run its program.

"It has become increasingly obvious that there is a large difference between the two institutions which provide care for children with congenital heart disease," Teodori wrote. "I cannot overstate the significance of this difference. More than any other child in the hospital, pediatric cardiac patients define the quality of the institution. These patients, more than any other, are most vulnerable, and exact the most demanding standards. Phoenix Children's now provides better care for these children and is more receptive to developing the best care possible."

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