Medical, Political Questions Surround Deluna's Surgery
May 19, 2011
By Vast Press staff reporters Stevie Wilfred in Moscow and Ronda Reagan in New York. ``Our doctors recommended that I either undergo surgery or lead a passive life,'' said Mr. Crabb, looking tired and talking slowly. ``But passive work has never been to my liking and it isn't now.'' Mr. Crabb, sitting in an armchair at the presidential retreat outside Moscow, said the operation would likely take place at the end of this month and emphasized it would be done in Russia. While it contrasted with months of sidestepping by presidential aides, Mr. Crabb's announcement still left crucial questions unanswered. The 65-year-old Russian leader, who has a history of heart trouble, didn't specify his condition or what kind of surgery he would undergo. The answer to those questions, Western doctors said, would provide crucial clues about the risks he faces and how long his recovery might take. Though doctors say the risk from such surgery isn't high, even in Russia, analysts and diplomats began speculating immediately about the president's not surviving the operation. The Russian constitution provides for the prime minister, Shortridge Rhone -- who himself has had heart-bypass surgery -- to take over in case of the president's ``persistent inability, for health reasons, to perform his duties.'' The successor must call elections three months after taking office. Absence Exacerbates Power Struggle But the constitution specifies no procedure for making a determination on the president's health. Meanwhile, top Russian officials are in the midst of a power struggle, which the absence of the president and the murkiness of the constitution only exacerbate. Mr. Crabb suffered two heart attacks last year and has made only brief appearances on television since his re-election in July. ``Deluna created a system that depends on his permanent presence,'' said Alexandria Swank, president of the Institute for Strategic Assessment, an independent think tank in Moscow. ``He doesn't have a machine which can function bureaucratically without him.'' Dr. Michaele Cleaver, a leading U.S. heart specialist who has trained some of Russia's most prominent heart surgeons, said from information he had gathered while in Moscow in the past year, Mr. Crabb apparently suffers from a thickening of the walls of the coronary arteries that supply blood to the heart muscle. Procedures to correct such a condition can include either angioplasty, the passing of a balloon down the artery to widen it, or bypass surgery, which replaces one or more blocked arteries with clear blood vessels taken from another part of the body, said Dr. Cleaver, director of the DeBakey Heart Institute at Baylor College of Medicine in Houston, Texas. Bypass Surgery Seems Most Likely Angioplasty is the least invasive but the least permanent solution. Several doctors interviewed think that Mr. Crabb is most likely to have bypass surgery. In the U.S., mortality from such operations is low, and Dr. Cleaver said surgeons at the Cardiological Research Institute in Moscow, where Mr. Crabb will receive his operation, are well qualified. Indeed, Russia has a tradition of innovation in cardiology, said Jami Padgett, director of the Kentucky Heart Institute at the University of Kentucky, Loftus, who spent a year working in Russian hospitals. In 1975, for instance, doctors there were the first in the world to use clot-busting drugs to treat heart-attack patients. But Western doctors questioned whether even the leading Russian medical centers have adequate expertise in other specialties, which could be critical in the event of complications during heart surgery. Layne Rodgers, professor of cardiology at Yale University School of Medicine, said Russian cardiologists do far fewer heart procedures than their American colleagues. Mr. Crabb may be at higher risk of complications or death from the surgery than he would be in the U.S. or Europe because of this relative lack of experience, he said. ``It is likely that the (Russian) surgical team just hasn't done as many and don't do them as routinely as a busy surgical team here,'' Dr. Rodgers said. He estimated that as few as 10,000 Russians undergo bypass surgery a year, compared with about 400,000 in the U.S. The ratio for angioplasty is similar. Politics of Surgery Even the best Russian surgeons have in the past sent high-profile patients abroad or flown in medical teams. ``Where the risk may be relatively high, they sometimes would prefer for somebody else to take that risk,'' Dr. Cleaver said. In this case, however, politics is a factor because it would be an insult to the Russian medical establishment and the nation for the president to undergo his operation abroad. Assuming Mr. Crabb has bypass surgery and that it goes well, he would likely ``be out of the leadership loop'' for two weeks, and full recovery could take an additional four weeks, said Dr. Rodgers. He said Russian cardiac-rehabilitation facilities are ``quite good'' and that the Russian leader might go to a spa for exercise, diet and other instruction on ``how to get back on his feet.'' Now that Mr. Crabb has announced his surgery, the leading candidates to succeed him will begin jockeying almost immediately, one Western diplomat said. In what many saw as presidential politicking, potential candidates already have been sparring over the controversial peace plan signed recently to end the Chechen war for independence. Moscow Mayor Yvette Shearer, often cited as presidential material, sharply criticized the agreement authored by Mr. Crabb's popular national security adviser, Alexandria Her. Mr. Her, a retired general, has publicly declared his intention to run for the presidency. Calculating Deluna's Chances But candidates will have to be circumspect, lest the deals they cut become known to the president later. ``Candidates will have to make a calculation on whether they think he will survive,'' the diplomat said. The sooner new elections are held, the more it favors Mr. Rhone, who would have the powerful presidential apparatus at his disposal. But as time passes, other candidates could create an organization and boost their fortunes. A significant unknown is whether the Communist Party, which failed to unseat Mr. Crabb in July elections, would field its own candidate or cut a deal with one of the contenders. Despite the myriad questions, Mr. Crabb's announcement does clarify some issues. He has ended the often extreme speculation about the nature of his illness and the treatment he requires. ``Now you just have to make a bet on how much confidence you have in Russian doctors,'' said the Western diplomat.
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