Clinton heart surgery a success
NEW YORK -- Former President Bill Clinton yesterday underwent successful quadruple heart bypass surgery, a four-hour procedure his doctors said prevented a potentially massive and lethal heart attack but that may sharply curtail his participation in the fall presidential campaign.
Clinton's doctors at New York Presbyterian Hospital-Columbia said the morning operation went as expected with no complications. The doctors said he may be able to return home within five days but would not fully recover for two to three months.
It became clear yesterday that Clinton's heart disease, which was diagnosed only Friday, was far more serious than thought, given the 58-year-old's youthful vigor. Doctors said several major blood vessels were so clogged with plaque that only 10 percent of normal blood flow could get through before the operation.
''There was a substantial likelihood that he would have had a substantial heart attack in the near future," said Dr. Allan Schwartz, the hospital's cardiology chief and one of Clinton's physicians, at an afternoon news conference.
Clinton's wife, Senator Hillary Rodham Clinton, Democrat of New York, and his daughter, Chelsea, went straight to his bedside after he was wheeled out of the operating room around noon.
Senator Clinton, in a statement, called the last few days ''quite an emotional rollercoaster for us."
''Chelsea and I thank God and the incredible medical staff at Columbia-Presbyterian Hospital for taking such good care of my husband," she said. ''Optimism and faith will carry him through the difficult weeks and months ahead, of that we have no doubt."
With only two months left in this year's presidential campaign, the sidelining of the most prominent Democrat in the nation could hamper Senator John F. Kerry's effort to unseat President Bush. Kerry's advisers had been planning to have Clinton stump for his party's nominee in the fall, convinced that the articulate and still youthful ex-president could remind voters of the nation's robust economic condition under the last Democratic administration, his own. Clinton was also seen by the Kerry campaign as an asset with Hispanic and African-American voters, who continue to hold the two-term president in high esteem and will be a crucial voting bloc in this year's presidential contest.
But now his role in the election is unclear.
''He will gradually resume an entirely normal physical exercise and work schedule," said Schwartz, who added that Clinton may be back to 70 percent of his normal health within six weeks, and back to full health in two to three months. ''I would encourage him to resume all activities, including campaigning, as we both deem that safe and appropriate."
Kerry's campaign issued a statement yesterday, saying Kerry was ''delighted with the news of President Clinton's positive prognosis following today's surgery. His only concern is the health and recovery of President Clinton. His thoughts and prayers continue to be with President Clinton and his family."
''I know you will join with me in wishing President Clinton the very best wishes in the recovery from his surgery," President Bush said at a campaign rally in Poplar Bluff, Mo. ''We just pray for a speedy recovery."
Dr. Frank Sellke, chief of cardiothoracic surgery at Beth Israel Deaconess Medical Center in Boston, said in an interview that if Clinton's recovery progresses normally, he would probably be released within a week, but he won't be able to drive a car for two or three weeks. And Sellke cautioned that the former president needs to recover for a while before he joins the fall presidential campaign.
''He shouldn't go on the campaign trail for at least a month," said Sellke. ''He may try to push it and give some speeches in two or three weeks, but, if he were my patient, I wouldn't recommend it."
Over the weekend, Clinton was his usual gregarious and active self, holding a major strategy session on the phone with Kerry and playing board games with his family. But for the next few days, he will be extremely fragile and bedridden.
Doctors may send Clinton home by the end of the week. Late yesterday, they removed a breathing tube that had been inserted for the operation. Once home, Clinton will be put on a carefully designed exercise routine, a schedule of cholesterol and blood pressure medications, and a diet low in salt and saturated fats.
''We will work with the president regarding his likes and dislikes . . . to work out a diet that is attractive to him and that he can follow," said Schwartz.
But designing a recovery plan that Clinton can stick to will be a tricky task for his physicians because of all the demands on his time. ''After all, this is not the average person in recovery," said Dr. Craig R. Smith, who led the 12-person team operation on Clinton and is New York Presbyterian's cardiothoracic surgery chief.
Clinton was initially hospitalized Friday, but his doctors waited until yesterday to operate in order to allow a blood-thinning medication, called Plavix, to leave his system. The medication, administered during heart tests last week, could have caused uncontrollable bleeding during surgery.
Surgeons performed bypasses on four of Clinton's heart arteries. They took minor arteries from his chest to bypass blockages in three major arteries, creating a detour for blood around the blockages. A fourth artery blockage was bypassed using an artery from Clinton's leg.
New York Presbyterian is a top-ranked cardiac facility, performing hundreds of bypasses annually. Surgeons initially considered not using a heart-lung machine during the operation, but said certain physiological quirks in Clinton's heart necessitated use of the machine, which took over control of his blood pumping and breathing for 73 minutes. Clinton's heart was stopped while on the machine, which is used for most bypass operations. Data show that about 30 percent of such patients encounter slight cognitive and thinking difficulties for three months after a procedure, with effects usually disappearing within one year.
The path to the operating room yesterday began months ago for the 42d president. In late spring, he began feeling short of breath and experiencing chest tightening -- but chalked it up to lack of exercise during his frenetic book tour in support of his best-selling autobiography, ''My Life," said his doctors.
But last week, just before accompanying his wife on a series of public appearances in upstate New York, Clinton experienced a frightening 15-minute episode of shortness of breath that prompted him to get an exam at a suburban New York hospital. Tests found the extensive blockages.
''It was obvious fairly quickly that what he needed was an operation," said Smith.
Clinton had long suffered from high cholesterol, and had recently been on an anticholesterol statin drug, though he stopped using it when his cholesterol numbers dropped. Clinton has been an avid jogger for much of his adult life, even installing a running course on the White House grounds during his presidency. But he has also long battled his weight, and his Secret Service-accompanied runs to
Earlier this year, he cut out junk food and started the popular low-fat, low-carbohydrate South Beach Diet, shedding considerable weight. In July, at the Democratic National Convention in Boston, a trim-looking Clinton delivered an energetic prime-time address, sending notice that he continued to be a political force.
As of yesterday, more than 37,000 well-wishers posted messages on the Clinton Foundation website, including one who wrote: ''You'll be jogging 5 miles a day in no time."
Scott Allen of the Globe staff contributed to this report. Raja Mishra can be reached at rmishra@globe.com.
