Former President Clinton Undergoes Successful Open Heart Surgery

REPORTER:

When might he be released from the hospital and when might he be able to return to a normal schedule? As you know he had a very busy schedule for the next couple of weeks – months.

DR. CRAIG SMITH:

That's hard to give specific answers to, except I can answer you in generality based on experience with similar patients which is to say that it would be common for him to be ready to leave the hospital within four or five days.

Right now, based on how he's doing, there's no reason to think he wouldn't fall within the same experience. After that, people are usually 70 percent or so back to baseline by around six weeks.

And to be really 100 percent in every respect takes two to three months in many patients. But there is quite a bit of variability.

REPORTER:

Doctor, what would have the president's prognosis been had he not had the surgery in lifespan, for instance, and what is it now that he's had the surgery?

DOCTOR:

So, because of the syndrome he had with progressive symptoms culminating in chest pain, there was a substantial likelihood that he who with have a substantial heart attack in the near future.

That was the reason for the time urgency of what was done. Since his heart muscle is normal and since after the surgery he's going to resume his very active exercise and we will work with him to control other factors that can lead to the recurrence of this disease, that with those things control with the normal heart muscle he will have normal longevity.

GWEN IFILL:

To help us understand more about the president's surgery– what it is, how it works, and how long it takes to recover– I'm joined now by Dr. Jonathan Reiner, a cardiologist from the George Washington University Medical Center.

He is the director of the cardiac catheterization lab there, and a member of the medical team seen by Vice President Cheney. Welcome, Dr. Reiner, thanks for coming in on a holiday.

DR. JONATHAN REINER:

Thanks for having me.

GWEN IFILL:

First, can you describe for us the surgery the president had today?

DR. JONATHAN REINER:

Sure. I brought a model to illustrate. President Clinton had coronary artery by-pass graft surgery, which is surgery in which the hard is accessed, where the breast bone is opened.

And the heart is isolated. And then the patient in the president's case is put on the heart lung machine. And the heart is cooled.

GWEN IFILL:

The heart is stopped while the surgery is going on?

DR. JONATHAN REINER:

That's right. The heart is cooled and then the heart stops, and this allows the surgical team to carefully graft new conduits, or by-pass grafts, onto his heart. What the surgeons did today was they took the mammary artery from the left side of his chest wall, and grafted that to two arteries on the front part of his heart: The left anterior descending and the branch. This major branch, the diagonal, they skipped to those two branches.

They then took the right internal mammary artery from the right wall of his chest and skipped that around to the back part of his heart. And finally, they used a piece of vein harvested from his leg and used that to by-pass a spot on the side of his heart.

GWEN IFILL:

How risky was the surgery?

DR. JONATHAN REINER:

Well, for a very vigorous man like President Clinton, 58-year- old man who has not had a prior heart attack, the risk of dying during this operation would fall somewhere in the 1 to 3 percent range.

GWEN IFILL:

Is this ailment that he was suffering from particularly common, and is this treatment very common?

DR. JONATHAN REINER:

First of all it's enormously common. Coronary artery disease affects about 20 million people in North America alone.

The particular syndrome that President Clinton presented with late last week, which we would call unstable angina, is a condition which several hundred thousand people in the United States have annually. So it's enormously common.

GWEN IFILL:

And this kind of procedure to fix it is a better option than other options?

DR. JONATHAN REINER:

Well, our options have evolved over the last decade. Coronary artery by-pass graft surgery was innovated about 40 years ago and really perfected over the last 20 years. So it's become a very common operation.

About 300,000 by-pass surgical procedures will be done in the United States this year. So it's about 1,000 a day. The other option for fixing this for patients with coronary artery disease would be angioplasty or coronary stenting.

GWEN IFILL:

Angioplasty is where you put the balloon in the artery and the stenting is the one we've heard so much about used on Vice President Cheney?

DR. JONATHAN REINER:

Right. Angioplasty came later been bypass surgery. In the late 70s the technique was first developed and refined really greatly over the last decade — most recently with the advent of stents that contain drugs to prevent re-narrowing within the stent. But the procedure isn't for everyone.

GWEN IFILL:

When they say today that the president's… several of his arteries were 90 percent blocked, and that meant it was too late for those two approaches?

DR. JONATHAN REINER:

Not having seen his images it's hard to know. But the notes from the medical team alluded to the fact that there were widespread lesions in at least three of his arteries.

GWEN IFILL:

I was struck by the fact that they said the president felt some tightening in his chest and shortness of breath over several months and it wasn't until this Friday that he felt I guess the pain that continued for 15 minutes resting.

Is this unusual for people to ignore symptoms or at least not to act on them and then finally, and then having to go straight to surgery, as what appears to have happened with the president?

DR. JONATHAN REINER:

No, it's quite common. Coronary artery disease usually progresses over a period of decades. And the narrowings that patients develop eventually becomes symptomatic in many patients, and it sounds like President Clinton was starting to notice some chest pain with exertion over the last at least several weeks.

The pain he had on Thursday, which was at rest was something new, and probably represent represented some clot forming in one of the arteries.

GWEN IFILL:

Now, when he came in on Friday, and they admitted him to the hospital, they still took until today to do the surgery and there was some discussion about why they waited and didn't act immediately.

DR. JONATHAN REINER:

Well, the president quite appropriately received a drug when he first presented last week called Plavix, and Plavix is a blood thinner, which is very effective the in preventing adverse outcomes in these patients.

But in patients who go to surgery, Plavix can increase the risk of bleeding. So the recommendations for wait about five days from a dose of Plavix until the patient goes to surgery.

GWEN IFILL:

There is also, I'm curious about what the risk factors are that people should be thinking about when they consider whether they are at risk for coronary artery disease. The president apparently had been on drugs for cholesterol for a while, high blood pressure. Are these the risk factors people should be aware of?

DR. JONATHAN REINER:

Sure. President Clinton had two or really three of the classically discussed risk factor, first of all male gender is a risk factor for coronary artery disease.

GWEN IFILL:

Why is that?

DR. JONATHAN REINER:

It's not clear to many people exactly why men develop coronary disease at an earlier age. I should say though that although male gender is a risk factor for coronary disease as women age, they catch up.

And coronary disease is the leading killer of women in this country as well. So gender in terms of male gender, hyper cholesterol, high cholesterol as the president had, hypertension, diabetes, increases the risk of coronary disease and seems to bring it on at a younger age, and tobacco use is an enormous risk factor. When we see young patients in their 40s with coronary disease, often we see patients who have had long tobacco history.

GWEN IFILL:

I realize you didn't work on the president's case, so I 'm not going ask you to speak about the president specifically. But in general for patients who have gone through this kind of procedure, what can they expect in the next several days, weeks, months?

DR. JONATHAN REINER:

For a big operation, recovery is really dramatically quick. The president will probably spend the night in the extensive care unit, and if he progresses well, potentially would go towards a step-down unit tomorrow, or at the latest the next day. And the patients now following bypass surgery are fast tracked. The goal is to get them up walking and out of the hospital very quickly, and a typical length of stay for an otherwise very healthy patient like President Clinton would be somewhere in the order of four to five days following this kind of surgery — then at home, although not really confined to home, with progressive increases in their activity.

GWEN IFILL:

Dr. Jonathan Reiner, thank so you much for helping us out.

DR. JONATHAN REINER:

My pleasure.