Yeltsin Is to Undergo Risky Heart Surgery

After 11 weeks of mysterious absences from the Kremlin, President Boris N. Yeltsin announced Thursday that he will soon undergo heart surgery--a risky operation that could leave Russia without an effective leader for months.

The 65-year-old president, looking pale and speaking slowly, broke the news in a televised interview, saying the procedure would be done near Moscow at the end of September. The evening announcement partially lifted the veil of Kremlin secrecy about the severity of his illness, but it raised questions about his prospects for recovery.

“I had a medical checkup and they found a heart disease,” Yeltsin said. “The recommendation of our doctors was either an operation or more passive work. I have never been satisfied by passive work. . . . It is better for me to have an operation and fully recover, as they promise, than to engage in passive work.”

His physical decline has set off an open struggle among his top aides for control of a nuclear-armed nation with an imperialist history and an uncertain commitment to democratic rules. The infighting has already complicated efforts to settle Russia’s 21-month-old conflict in breakaway Chechnya and is expected to intensify until Yeltsin regains his vigor, if he ever does.

Although Yeltsin did not specify the kind of operation, a spokesman for Moscow’s Cardiology Research Center, Vitaly I. Dmitriyev, said the president will undergo coronary bypass surgery there.

The president was hospitalized twice last year, in July and October, for myocardial ischemia, a condition that restricts the flow of oxygen to heart muscles and can presage a heart attack. It is the most common heart ailment--and cause of death--in the United States and Russia.

Yeltsin recovered without surgery to wage a vigorous campaign for reelection but suddenly dropped from public view about two weeks before his victory July 3. Since then, his only public appearances have been in brief, carefully edited television footage and a slurring, stiff-legged performance at his Aug. 9 inauguration.

Bypass surgery is a routine procedure in the United States, where it is performed about 350,000 times a year, compared with about 20,000 such operations in Russia. It involves diverting blood around a clogged portion of the patient’s coronary artery by grafting onto it a piece of artery or vein removed from elsewhere in the body.

“It’s as simple as an appendectomy,” said Dmitriyev. “He will recover in no time.”

Other medical specialists warned that the operation is quite risky for Yeltsin and might require as long as three months’ convalescence.

While most U.S. patients live 10 years or longer after bypass operations with no recurrence of the disease, such surgery in Russia is less advanced and relies on techniques abandoned in the West, according to specialists in both countries.

The Kremlin never disclosed the seriousness of Yeltsin’s two illnesses last year or his recent relapse. If Yeltsin has suffered a stroke or a severe heart attack, bypass surgery would do nothing by itself to repair the damage.

“Given the lower quality of this procedure in Russia, given Yeltsin’s hard lifestyle and given that he may have had some damage to his heart, his prognosis is not very good,” said Manuel Cerqueira, associate chief of cardiology at Georgetown University Medical Center in Washington.

Ivan Rykunov, head of the cardiac surgery research lab at the Russian Academy of Sciences, said it is common to do this operation on people up to 65, Yeltsin’s age, but, “after that, patients are considered high risk.”

The death rate during bypass operations in Russia is similar to that in the West, doctors here say, but the danger for Yeltsin is probably far greater. A man with a long history of illness, punctuated by bouts of public drunkenness, Yeltsin has already lived seven years longer than the life expectancy for Russian males. It is not known whether he has a medical condition that would complicate heart surgery.

Yeltsin’s doctors reportedly considered sending him abroad for the operation, but the president rejected the idea. “The president should have operations at home,” he said.

The Cardiology Research Center is Russia’s leading hospital for heart patients. It is headed by Yevgeny Chazov, the doctor who kept the ailing Leonid I. Brezhnev alive after he became unable to run the Soviet Union.

Much as it did during Brezhnev’s decline, the Kremlin has misled the public about Yeltsin’s health. All summer his handlers refused to admit that the president was suffering anything more serious than a cold, a sore throat and fatigue.

Yeltsin’s interview, conducted by RIA-Novosti Television and aired on all national channels, was the first time a Kremlin leader had so openly discussed his health.

“I want to have a society based on truth,” said Yeltsin, who was at a Kremlin hunting lodge in Rus, 60 miles northeast of Moscow. Pale and puffy, he gestured listlessly with both hands. “That means no longer hiding what we used to hide.”

The president did not say whether he would hand presidential power during his surgery to Prime Minister Viktor S. Chernomyrdin. In the event of Yeltsin’s death, Chernomyrdin would by law become president but would have to call a presidential election within three months.

Having endured a divisive campaign in which Yeltsin beat back a strong Communist challenge, Russians have little desire for another election soon. But already ambitious men are maneuvering fiercely for power.

Security chief Alexander I. Lebed, for example, has moved swiftly and boldly, with little support from the president, to make peace with rebels in Chechnya. Chernomyrdin and Yeltsin’s chief of staff, Anatoly B. Chubais, have damned Lebed with faint praise, while Moscow Mayor Yuri M. Luzhkov and Communist leader Gennady A. Zyuganov have accused him of surrendering the tiny republic.

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BACKGROUND

Russia’s rules of succession, as written in the constitution, state that the prime minister would run the country for three months if the president died or was found incapable of carrying out his duties. The upper house of parliament would then call early elections. During that period, the prime minister cannot dissolve parliament, call referendums or change the constitution.

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Yeltsin’s Heart Repair

Boris Yeltsin was hospitalized twice last year for myocardial ischemia, a condition that restricts the flow of oxygen to heart muscles and can presage a heart attack. The most likely surgery for that condition apparently would be a coronary artery bypass. Sample blockage and bypass shown here.

Bypass: The saphenous vein is taken from the leg and used to replace the blocked artery.

Possible scarring: If Yeltsin has had previous heart attacks, resulting in scarring that could have developed into a heart aneurism.

Number of bypasses done a year:

Russia: 20,000

U.S.: 350,000

Sources: Dr. Stephen Large, cardiac surgeon, Bloomberg, staff and wire reports