Yeltsin bypass `success' leaves doubts

ALTHOUGH his open heart surgery has been declared a success, it has emerged that President Yeltsin's heart was in a more serious condition than anticipated.

Prof Renat Akchurin, who performed the operation, said a prognosis for the president's recovery could not be made for five or six days.

At a press conference at the Moscow Cardiological Centre where the seven-hour operation took place, Prof Akchurin would not reveal the extent of surgery but said that more than four bypasses were performed.

The leading American surgeon, Dr Michael De Bakey, said that the operation had been successful. In operations of this nature three-quarters of patients led active lives 10 to 15 years after surgery, he said.

A Western surgical expert told The Irish Times last night that a quintuple bypass may have been performed on Mr Yeltsin but that there had been cases of six or seven bypass grafts being carried out.

According to the expert, a number of dangers could face Mr Yeltsin in the coming days, the most serious of which is haemorrhaging which could pose a grave danger.

There have also been cases of sudden heart failure after such operations. Clotting of the blood leading to a stroke is another possibility, as is failure of the kidneys.

While aware of these possible problems, Mr Yeltsin's team of doctors was in confident mood after the long operation and was not expecting any such complications.

Mr Yeltsin, whose heart was stopped for 68 minutes, was breathing with the help of a respirator after the operation and regained consciousness early yesterday evening. He will undergo a series of tests over the next few days.

The operation came after he had suffered three heart attacks in the past 15 months. He was first hospitalised with a heart condition in November, 1987, after he had been sacked as the Communist Party's Moscow city boss, and according to sources in Moscow, he may have had his first heart attack when he was a 19-year-old in his native Sverdlovsk (now Yekaterinburg).

Damage to the heart tissue caused by these heart attacks will not have been repaired by yesterday's surgery but, according to experts, tissue which had merely been deprived of oxygen stood a chance of recovery.

On the political and economic front, however, the prognosis looked poor. In Moscow yesterday, the city's arteries were clogged by traffic jams following a demonstration by workers who had not been paid for months. There were other demonstrations throughout the country by unpaid workers who now face the onset of the Russian winter in regions where electricity supplies have become haphazard.

The Prime Minister, Mr Viktor Chernomyrdin, who retained the role of acting president last night, will hand back the reigns of power to a president who will need all his physical and mental strength to rectify a situation which has reached the greatest crisis point since the dissolution of the Soviet Union in December, 1991.

Political stability will he a prerequisite for Russia's recovery and there is no certainty that this will be the case. Observers forecast that Mr Yeltsin will carry out yet another purge of the Kremlin administration as his health gathers strength.

He has not been Russia's most stable ruler, his temperament having been more suited to the smashing of old structures than to replacing them with a stable system.

Mr Yeltsin, who has found it difficult to settle matters by negotiation, resorted to force to put down his parliament in 1993 and began a horrific war in Chechnya in which tens of thousands of civilians lost their lives.

His other great difficulty has been in choosing the right people to surround him. With the exception of Mr Chernomyrdin, who was forced on Mr Yeltsin as Prime Minister by the very parliament against which he sent in the tanks, almost every other member of the government will feel insecure as the president's strength and determination returns.

Men such as the Kremlin chief of staff, Mr Anatoly Chubais, who has been seen to wield great power behind the scenes during the illness which has partly incapacitated Mr Yeltsin for more than five months, will soon lose his clout.

Mr Chubais has been sacked before and he could be sacked again. It is more likely, however, that some of the entourage he surrounded himself with in recent weeks and months will be unceremoniously chopped.