Heart Risks May Delay Yeltsin’s Operation

In a sign that President Boris N. Yeltsin’s heart surgery may be postponed or even canceled, the doctor chosen for the job said Saturday that damage caused by the Russian leader’s newly disclosed heart attack this summer might make the operation too risky or of little help.

The assessment by Dr. Renat Akchurin--coupled with a pessimistic report by the Kremlin’s chief physician--indicates that the doctors are resisting pressure from the 65-year-old Yeltsin and his political aides to hurry a coronary bypass operation.

Until Friday, Yeltsin’s doctors had said little about his condition after the president’s Sept. 5 announcement that he would undergo surgery at the end of the month. Their preliminary judgments were based on electrocardiograms and other tests on Yeltsin over the last week.

A decision on the surgery is expected Wednesday or Thursday at a meeting of the doctors. They have invited the American heart specialist Dr. Michael DeBakey, who will be in Moscow for a conference, to contribute his advice.

Their decision will affect the political direction of this nuclear-armed nation, which is struggling to establish democracy but lacks clear rules of presidential succession.

If Yeltsin was judged unfit for surgery, it is unlikely he would recover the vigor he needs to reassert full control over the government. A succession struggle involving his prime minister, his security chief, his Communist foe and others--underway since he fell ill three months ago--would only intensify.

Yeltsin and some advisors, particularly his chief of staff, Anatoly B. Chubais, favor prompt surgery, hoping it will restore his health and authority. The president has said his other option, “to work passively,” is unacceptable.

On Saturday, Chubais told a meeting of Russia’s Democratic Choice party: “Those politicians who believe that it is time to take up starting positions in a presidential campaign will very soon realize that they have jumped the gun.

“Those who have got off to a false start will be forced to hang their heads and go back to the starting line under the intent gaze of the judge, who was, is and will remain the president of Russia.”

But Akchurin, who trained with DeBakey and is chief of cardiovascular surgery at Moscow’s Cardiology Research Center, is building a subtle case in public against rushing to surgery.

On Friday, he infuriated the Kremlin by disclosing in an interview with ABC News that Yeltsin had suffered a heart attack this summer--sometime between the first round of presidential balloting June 16 and his reelection July 3. Yeltsin’s press service demanded that Akchurin retract his statement.

But in brief remarks Saturday, the 50-year-old surgeon insisted, “We saw scars on the electrocardiogram”--evidence, he said, of fresh damage to Yeltsin’s heart tissue.

Although he did not treat Yeltsin’s summer illness, Akchurin said the damage he detected last week could have resulted only from a recent heart attack. He said the damage “might be” a complication that would make Yeltsin’s surgery risky or of little help.

“It was the goal of my interview [with ABC] to say that we can postpone the operation,” the surgeon said, although he did not rule out going ahead with it.

Akchurin did not elaborate on his risk assessment. But other specialists in Russia said they prefer to delay any heart surgery for six months after a heart attack to give the damaged tissue a chance to heal.

In bypass surgery, a new blood vessel is grafted onto arteries that supply the heart muscle, creating a detour around blockages in those arteries. Yeltsin was hospitalized twice last year for a constricted blood flow to the heart, and it is believed--but has never been confirmed by any doctor--that at least one of those episodes resulted in a heart attack.

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Another possible concern about surgery on Yeltsin is that it might endanger his life for no gain. If a blocked artery feeds a part of the heart damaged by an attack, specialists say, bypassing that blockage will not bring additional blood to the heart’s healthy tissues.

In addition, Dr. Sergei Mironov, the Kremlin’s chief physician, has raised concerns that Yeltsin’s other organs may be too unhealthy to withstand a heart operation.

“To prepare for such an operation, we need to consider the condition of all the patient’s organs and systems. And of course, all of us through life acquire rather a lot of organ problems. Unfortunately, Boris Nikolayevich also has them,” Mironov told reporters Friday, without elaborating.

As apparent complications prolong his pre-surgery stay in the Kremlin hospital, Yeltsin’s press service keeps insisting that nothing is wrong. Last week, it released silent film of a relaxed-looking president chatting and gesturing in a hospital meeting with Prime Minister Viktor S. Chernomyrdin.

When Yeltsin checked into the hospital a week ago Friday, his press service said it would be for the weekend. On Tuesday, when he was still there, presidential spokesman Sergei V. Yastrzhembsky said, “I don’t see any big problem here at all.”

Doctors kept Yeltsin in the hospital this weekend.

“The Russian doctors are doing damage control,” said Dr. Manuel Cerqueira, associate chief of cardiology at Georgetown University Medical Center in Washington.

“They obviously don’t want anyone to think this is a slam-dunk operation and take the blame if he doesn’t come out of it. And they’re trying to get some outsider opinions to support what they’re saying, which is smart on their part.”

While most Russian voters suspected this summer that something was wrong with Yeltsin’s heart, Akchurin’s disclosure of his attack caused a political storm.

Noting that the government had covered up the attack in the days before the runoff election between Yeltsin and its leader, the Communist Party claimed again that Yeltsin is unfit to govern and demanded a new election.

Under the constitution, the prime minister would take over and a new election would have to be held within three months if a president died or became incapacitated. But nothing in the charter spells out who would decide on the president’s fitness to rule.

Last week, Yastrzhembsky announced that Yeltsin would sign a decree handing Chernomyrdin full but temporary presidential powers before undergoing surgery. The spokesman said Yeltsin would sign another decree taking his powers back as soon as he recovered.