Yeltsin Heart Operation Called a SuccessBy David Hoffman
Washington Post Foreign Service
Wednesday, November 6 1996; Page A03
President Boris Yeltsin underwent a seven-hour operation today to circumvent five clogged arteries supplying blood to his heart. Surgeons and Kremlin officials announced that the operation had been a success and that Yeltsin regained consciousness tonight.
[Yeltsin reclaimed his presidential powers Wednesday morning by signing a decree, his spokesman, Sergei Yastrzhembsky, told the Reuter news agency. "The president is regaining his strength quite quickly," Yastrzhembsky said.]
Yeltsin earlier had transferred his formal powers to Prime Minister Viktor Chernomyrdin, including the black attache case carrying codes to activate nuclear weapons. Chernomyrdin and Yeltsin's wife and daughters remained at the hospital during the surgery.
Yeltsin, 65, was reported to be in stable condition. He remained connected to a mechanical ventilator in intensive care, and physicians said he faced a difficult postoperative period.
Naina Yeltsin said in a brief television appearance that she had not been able to see her husband but was assured by his doctors that the operation was successful. "We're very worried, of course, very worried," she said, apparently holding back tears.
Renat Akchurin, the surgeon who led the medical team for the operation at the Moscow Cardiological Center, told reporters the surgery was without complications. Yeltsin's heart is "getting enough blood to function normally," he said.
The surgeons created a new system of blood supply to much of Yeltsin's heart. The existing network of vessels was inadequate because many sections were narrowed or entirely blocked by fat deposits, limiting the supply of blood and oxygen to the constantly beating heart. Such a problem can cause chest pain, damage to the organ's pumping capacity and death.
In Yeltsin's case, two blood vessels were used to create the new network in a procedure known as coronary artery bypass grafting.
One vessel was the left internal mammary artery, which runs alongside the breastbone and gives off branches to the ribs and breast on the left side of the chest. It was cut partway along its course and attached -- or grafted -- to one of the president's coronary arteries downstream from the narrowed area. The tissues that normally would be served by the internal mammary artery are not hurt by this procedure because they are served by other arteries as well.
The second vessel was the saphenous vein, which runs up the inside of the leg. It was tied off, cut and transferred to the chest, where pieces of it were used to detour blood around narrowed vessels.
Although it is technically difficult to graft with the internal mammary artery, the effort is worth it. Whereas only 40 to 60 percent of saphenous vein grafts are still open 10 years after surgery, more than 90 percent of internal mammary artery grafts are. On average, people who have had internal mammary grafts also live longer.
Asked whether Yeltsin had required a triple or quadruple bypass, Akchurin replied, "The number of bypasses significantly exceeds the number you mentioned. And the operation went normally."
Akchurin refused to be more specific, saying of Yeltsin, "What he has inside is his personal business." But Akchurin also said, "I did what a surgeon should do and completely re-vascularized the heart muscle." He added that "it happens that one bypass helps a lot, and sometimes five to six bypasses save the patient and re-vascularize [create a new system of vessels for] the heart."
A surgeon who witnessed the surgery on closed-circuit television, George P. Noon of Houston, said that five vessels were bypassed in the operation. Noon came to Moscow with Michael E. DeBakey, the pioneering American heart specialist invited to advise the Russian team that carried out the surgery.
According to Noon, the arteries bypassed were the right coronary artery, the left anterior descending coronary artery and one of its diagonal branches, and two branches of the circumflex coronary artery. The mammary artery was used for the left anterior descending, while the leg vein was used for the others, he said. No other procedures were carried out during the surgery, he added.
Yeltsin's heart was stopped for 68 minutes during the operation, Akchurin said. A completely still heart is necessary for surgeons to do the extremely fine sewing necessary to create the bypass grafts. During that period, the blood is circulated by a heart-lung machine.
The president was brought to the hospital from a government resort outside the city in a pre-dawn motorcade, and the operation began at 7 a.m. (11 p.m. EST Monday). Akchurin was assisted by a team of 12, including four surgeons.
Although they were not involved in the actual surgery, DeBakey and the other foreign advisers, including two German specialists, are expected to help with the critical postoperative period.
In the month before the operation, Yeltsin lost a great deal of blood, apparently from some part of his stomach or intestinal tract. The exact site of the bleeding, however, was never found. During surgery Yeltsin was given high doses of blood-thinning drugs, and the medicines almost certainly will be used at lower doses during the recovery period. The foreign consultants will aid the Russian doctors in monitoring Yeltsin for renewed bleeding and in managing any other problems that may arise, Akchurin said.
DeBakey, a professor at the Baylor College of Medicine in Houston and one of the original developers of coronary artery bypass grafting, declared the operation "a complete success." The 88-year-old surgeon is a frequent visitor to Russia and helped train Akchurin, who spent two years in Houston in the 1980s.
"On the basis of the results of this operation at the present time, I would predict that President Yeltsin will be able to return to his office and carry out his duties in a perfectly normal fashion," DeBakey said. Akchurin was more cautious, saying he would not venture a prognosis for five or six days.
"In terms of the length of time after the operation for a bypass to continue to support the heart," DeBakey said, "in most studies that have been done in this regard, we can say that for 10 or 15 years after the operation, almost three-fourths of the patients are leading a normal life."
Yeltsin's life has been anything but normal. In addition to the upheavals of Russia's transition to a free-market democracy, Yeltsin has been sidelined repeatedly over the last 18 months because of his heart disease. After a surprisingly vigorous reelection campaign, he suffered his third and latest heart attack in late June and announced Sept. 5 that he had agreed to undergo the surgery.
He turned to Akchurin, who carried out similar surgery on Chernomyrdin eight years ago. The public focus on Akchurin had become intense, especially given the generally miserable state of Russian health care. While some people asked whether Yeltsin should not seek help abroad, Yeltsin insisted he would have the operation in Russia.
Although DeBakey was invited as a consultant, Kremlin officials displayed unusual sensitivity to the presence of the foreign physicians. "I think no one doubted the Russian doctors' skills," said Yastrzhembsky, Yeltsin's spokesman, who reported that the American team had arrived only in the fifth hour of the operation.
"Every time you enter the operating room, you experience the burden of enormous responsibility to any patient, because he trusts you," Akchurin told reporters after the operation today. "I tried to forget that this is the president of Russia, and I was thinking that this is a patient."
Chernomyrdin telephoned President Clinton today to tell him that Yeltsin's surgery had been successful, after Clinton had sent both official and personal messages to Moscow voicing hopes for Yeltsin's speedy recovery, the White House said.
Yastrzhembsky read to reporters the text of a message Yeltsin prepared before the surgery. "I do not want to stay long in the hospital," he said. "I believe that I will soon be able to work as before -- with full strength."
Yastrzhembsky said Yeltsin was in good spirits before the operation. When he saw Sergei Mironov, head of the president's medical service, Yeltsin joked, "You got your knife all ready?"
Staff writer David Brown contributed to this report from Washington.