Yeltsin's heart damage may make bypass too risky, his surgeon says Russian leader suffered a heart attack in June or July, doctor confirms

September 22, 1996|By NEW YORK TIMES NEWS SERVICE

MOSCOW -- In sharp contrast to statements by the Kremlin about the health of President Boris N. Yeltsin, Russian doctors have begun to paint a grim picture of a seriously ill leader.

Confirming long-standing rumors, the Russian surgeon who is to operate on the president said Friday on the ABC News program "Nightline" that Yeltsin suffered a heart attack before the presidential runoff election in July.

And yesterday the surgeon, Renat Akchurin, said that because of damage to the heart "it might be" too risky to go ahead with the planned bypass surgery.

Yeltsin is currently in the Moscow Central Clinic Hospital for what have been described as pre-surgery tests. Yeltsin entered the hospital last weekend for what officials said would be a few days, but his stay has already been extended three times.

The sharp contrast between the account by Yeltsin's doctors and that of the Kremlin has unnerved the political establishment and reinforced the public's distrust of Kremlin statements.

The reports are also fanning a spirited debate among Russian specialists about whether Yeltsin has made the correct decision by choosing to have his operation in Russia instead of the West.

"I do operations on a daily basis, but I am sorry to say that if the operation was done in the West it would be more reliable," said Mikhail Alshibaya, a top surgeon at the Bakulev Institute for Coronary Surgery in Moscow.

"Akchurin is a brilliant surgeon," he said. "His team is not bad. But they do maybe 100 or 120 bypass operations a year. And as far as I know, they do not handle the most serious cases."

To be sure, Yeltsin presents a complicated case for an experienced doctor. He has suffered for years from myocardia ischemia, a condition in which constricted arteries hamper the flow of oxygen to the heart muscle. And his determination to run for re-election led him to put off the bypass, making his prognosis more problematic.

In discussing Yeltsin's health yesterday, Akchurin told Reuters that while he was not treating the president earlier this summer, new evidence of scarring on the heart led him to conclude that Yeltsin had suffered a heart attack in late June or early July. Such attacks can permanently damage the heart, hampering the chances of recovery after an operation.

The decision by Yeltsin's physicians to publicly describe the serious state of the president's health has prompted speculation in Moscow that they are worried about being blamed if Yeltsin fails to regain his health or dies.

But it also has raised a larger question: Should Yeltsin have sought treatment in the West?

The cardiology center where Yeltsin is expected to have his operation is headed by Dr. Yevgeny Chazov, a former Soviet health minister.

Akchurin was trained by Dr. Michael DeBakey, the world-renowned heart surgeon of the Baylor Medical Center in Houston, who has agreed to consult on Yeltsin's operation. DeBakey said that Akchurin was so proficient that he would be willing to put him on his own staff.

The debate among Russian physicians, however, is not so much about Akchurin's technical skill as a surgeon, but revolves around the center's experience in handling complicated cases.

Russian experts say the center has less experience than comparable facilities in the West. They also say that assembling an ad hoc team of Russian and international specialists was riskier than going to a Western hospital with a team that is used to working together.

But other specialists are far more generous in their praise for the center.

"As far as I am concerned, it is really first class," DeBakey said.

But he also cautioned that the center may not have a broad range of experts on the array of ailments that might complicate Yeltsin's surgery.

The center is not attached to a medical school or university, as is common in the United States.

"Almost every cardiovascular center I know is backed up by a university or medical school," DeBakey said. "What Chazov has done to compensate for that, I do not know."

Pub Date: 9/22/96

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