Clinton Recovering After Quadruple Bypass

Former president expected to leave hospital within 4-5 days

TUESDAY, Sept. 7, 2004 (HealthDayNews) -- Former President Bill Clinton was alert, talking with his family and drinking liquids on Tuesday, one day after undergoing quadruple heart bypass surgery.

He remained in intensive care at New York Presbyterian Hospital/Columbia and was resting comfortably, according to a statement from his office.

"He is awake and alert and talking with his family," the statement said.

Clinton underwent a successful four-hour quadruple heart bypass operation Monday morning. He was breathing on his own after being taken off a respirator that evening, his doctors said.

Speaking on NBC's "Today" show Tuesday morning, Dr. Craig R. Smith, chief of cardiothoracic surgery at New York Presbyterian Hospital/Columbia who headed the surgical team, said that Clinton was sitting up in bed and was able to talk with doctors.

Dr. Robert E. Kelly, a member of the surgical team who is also heading the recovery team, told the audience, "Everything is going very well."

The operation began Monday morning at 8 a.m. and was what doctors termed "relatively routine."

"We left the operating room around noon and he is recovering normally at this point," Smith told a news conference late Monday afternoon.

"Right now, everything looks straightforward," Smith added.

Dr. Allan Schwartz, the hospital's chief of cardiology, told the news conference that an angiography had revealed extensive blockage in each of the blood vessels feeding Clinton's heart. The heart itself, however, was "strong with absolutely no damage," Schwartz added.

The 58-year-old former president's recovery will start in an intensive care unit and progress to walking before he is released from the hospital within four to five days, Schwartz said.

At home, Schwartz added, Clinton will have a gradually increasing schedule of exercises to follow and will eventually have "an entirely normal physical exercise schedule." He will not need home nursing, and he will be on a new diet that is low in saturated fat and salt content.

While full recovery typically takes months, Schwartz said, Clinton can be back at about 70 percent within a few weeks. It is not clear when the former president can go back on the campaign trail, or whether he will entirely miss the remaining weeks leading up to the election.

Although the decision to have open heart surgery was made last week, surgeons waited until today, they explained, because Clinton had been placed on blood-thinning medication.

"It was our decision that it would be safest until the medication had decreased to greatly cut down the chance of bleeding with surgery," Schwartz said.

"He presented on Friday and after a through review of the anatomy, it was obvious fairly quickly that what he needed was an operation and equally obvious that the safety of operation would be improved if we waited a few days," Smith added.

The former president was already taking an ACE inhibitor for high blood pressure and a statin to lower cholesterol. His LDL ("bad") cholesterol when he was admitted to the hospital Friday was 114. According to the American Heart Association, people with heart disease should have LDL levels of 100 or less.

Bypass surgery, which can be done after a heart attack or to prevent a heart attack, involves using another artery or vein to bypass a narrow, blocked artery feeding the heart, according to Dr. Robert Bonow, chief of cardiology at Northwestern University in Chicago and past president of the American Heart Association.

Three of the four replacement vessels came from Clinton's chest wall. Only one came from his left leg. Typically in quadruple bypass, vessels from the leg are also enlisted.

During the operation, Clinton was on a bypass pump for 73 minutes. The pump or heart-lung machine basically takes over for the heart while the surgeons are working.

A statement from Hillary and Chelsea Clinton read at the news conference said that the family had "stayed up pretty late last night talking, playing games and just being with each other. These past few days have been quite an emotional roller coaster for us, as so many families know. Open heart surgery, though increasingly common, is a very serious procedure."

According to Schwartz, initial evidence of Clinton's heart problems manifested several months ago when he noticed that he was getting short of breath and developing some chest constriction with activity.

"The amount of activity that produced these symptoms gradually declined and he ultimately had an episode of discomfort at rest lasting 15 to 20 minutes which led to hospitalization," Schwartz said.

"It was basically a warning," said Dr. Abraham Bornstein, a cardiologist who is an assistant professor of medicine at Cornell's Weill Medical College at New York Presbyterian Hospital. "It's very lucky he heeded it."

More information

Visit the Clinton Presidential Center for updates on the former president's recovery.

SOURCES: Abraham Bornstein, M.D., assistant professor, medicine, New York Presbyterian Hospital, New York City; Robert Bonow, M.D., professor, medicine, chief, cardiology, Northwestern University, Chicago, and past president, American Heart Association; Sept. 6, 2004, news conference with Craig Smith, M.D., chief of cardiothoracic surgery, and Allan Schwartz, M.D., chief of cardiology, New York Presbyterian Hospital/Columbia, New York City
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