Left Houston with George Noon on KLM 662 at 3:55 pm and arrived in Amsterdam at 7:30 am Sunday, November 3, 1996. We were
graciously escorted to the Special Lounge and then escorted to the gate to take KLM 287 leaving for Moscow at 9:05 am and
arrived at the airport in Moscow at 2:15 pm. On this flight were in addition to Dr. George Noon: Dr. Clarence Alfrey, Dr.
David Yawn, Gary Cornelius (pump technician), Suellen Irwin (O.R. nurse), and Dr. Peer Portner (Chairman of Novacor).
We were met by Dr. Chazov and various deputy executives from the Kremlin (Sergi Loukash and Anna Bogomolova were also at the
airport and again are attached to me). We were informed that we would be staying at the Barvija Sanitorium. Dr. Chazov and
I were driven in a Mercedes to the Sanitorium where we met Renat Akchurin and Michael Lepilin. I was taken to my suite, consisting
of a living room, a bedroom, and 2 baths. It overlooks the woods and is very comfortable.
We all then had dinner, with the usual toasts, and were all informed that tomorrow we would review all the medical data on
President Boris Yeltsin.
Monday, November 4, 1996
After breakfast, the director of the Barvija Sanitorium, Dr. Valentin Artsibashev, took us on a tour of the grounds, which
encompass about 350 acres of beautiful wooded country, with a lovely lake with geese, ducks, and white swans. It was originally
an estate of a German Baron and Baroness established in 1895. The castle of their home still stands and is used as an entertainment
center. It was taken over by the Communists in 1917, and in World War II, a military hospital was first built on the estate,
The current Sanitorium was built shortly after World War II, gradually enlarged, and now has a capacity of 177 patients, all
of whom are referred. It is usually used by VIPs and high government officials. President Yeltsin was living here in a special
Later I met with President Yeltsin's physician, Dr. Vladilen Vtoryshin, who told me that the President had been asking
for me and felt warmly toward me, with sincere gratitude. Dr. Vtoryshin showed me the latest medical data, all of which were
most encouraging. The latest echocardiogram showed an ejection fraction of 40, a striking improvement over the figure of
20 approximately five weeks ago. The RBC was 3.85 million, Hb 12.5, and hemocrit 36. The thyroid function studies were normal.
He was now normotensive and asymptomatic.
Later, we met with the entire medical team, including Dr. Chazov and Dr. Akchurin, and discussed all the findings and agreed
unanimously that he was ready for the operation and that it could take place tomorrow morning. I was then asked to go see
him and give him this report.
When I walked into the room, he was standing and greeted me warmly, embracing me and kissing me in the traditional Russian
form of greeting, stating how glad he was to see me again and how grateful he was for my services. I gave him our report,
stating that he had now improved sufficiently to go through the operation satisfactorily and was ready for the operation tomorrow.
I explained that when I saw him previously, I recommended a delay in the operation to correct certain problems, and that these
had all been corrected. I also told him that there was now only the normal risk of the operation and that he should obtain
a highly satisfactory result and could return to his official duties and discharge his term as President. I also gave him
President Clinton's best wishes and complete support. He then gave me his book, The President - 96, which he autographed
with kind sentiments and gratitude and embraced me before departing.
At dinner, later, we toasted his complete recovery. We were instructed to be ready to depart for the Cardiology Research Institute
at 9:45 am the next day.
Tuesday, November 5
Breakfast at 9:00 am, and then we were driven at 9:30 am to the Cardiology Research Institute. Dr. Chazov met me at the door
and escorted us to a room adjoining the operating room, with a large monitor showing the operative field.
Dr. Akchurin and his team had already begun the operation (at 8 am), and at this time were performing an autogenous saphenous
vein bypass (a good vein) to the first obtuse marginal. When this was completed, he performed an anastomosis with the vein
to the diagonal coronary artery. He then performed an anastomosis to the right coronary artery, also with the vein and subsequently
to the posterior descending branch. Finally, he performed an anastomosis to the LAD, using the left internal mammary artery.
He then released the clamp on the ascending aorta, and the heart immediately began to contract normally, but some manipulation
around the heart caused it to fibrillate, so he shocked the heart, after which it began to contract normally. The heart was
in standstill from cardioplegia and ascending aortic clamping for 68 minutes.
Dr. Akchurin then applied a partial occlusion clamp to the ascending aorta and made openings to anastomose the veins, thus
completing the revascularization.
[Diagram = 5 bypasses]
The heart's contraction continued to improve, and, just before closure, one could observe that it was contracting vigorously.
They then weaned the patient off the pump and gave him protamine. A temporary wire pacemaker was also used. It took about
an hour to start the closure, owing to great care to assure good coagulation and no oozing of blood. The field was dry as
closure was begun. The entire operation took about 5 1/2 hours.
Drs. Akchurin and Chazov then came into our room and stated that the patient's blood pressure, rhythm, and other functions
were perfectly normal.
Later, we had a "victory toast" with champagne that Dr. Chazov brought out in his board room, and the medical team
drank a toast to President Yeltsin's good health.
Mrs. Yeltsin and her daughter, Tatayana, along with Prime Minister Chernomerdin, greeted us and thanked me kindly for my services.
About 3 pm a news conference was held, and each of us, including Drs. Akchurin and Chazov, gave a statement about the operation.
I emphasized that I was gratified that the operation was highly successful, as I predicted it would be after my first consultation
following the waiting period I recommended and the correction of the abnormal condition, including particularly the anemia.
I was asked when I thought the President could return to his office, and I stated that he could probably resume some official
activities in several weeks and normal activities in a few months.
Wednesday, November 6, 1996
Breakfast at 8 am, and at 9 am we left for the Cardiology Research Center for the first postoperative Concilium Day.
Dr. Akchurin and Dr. Lepilin gave us a report that President Yeltsin was extubated at 6 am and was now resting comfortably.
All vital signs were normal. He was alert and responding normally, BP 130/80, EKG showed normal sinus rhythm, Hemoglobin 12.8,
RBC 3.9 million, Platelets 130,000. Very little drainage from the chest tubes. The PO, was 76, and oxygen saturation was
92 (we suggested increasing his pulmonary exercises and stimulating coughing).
It was generally agreed that his postoperative status at this stage was excellent and highly gratifying. His cardiac function
seems to be virtually normal.
We then went into the recovery room to see the President. He was wide awake, greeted us warmly with a smile, and thanked us.
I was asked by his physicians to emphasize the need for him to remain in the recovery room for a few more days (he had already
asked to be moved back to the Central Hospital). I told him that he was progressing highly satisfactorily and that he would
have a complete recovery as I had promised when I saw him the first time and again the day before the operation. It was important,
however, for him to be patient and to follow the instructions of his physicians, who were managing him so well, that he must
stay in the recovery room where all monitoring, therapeutic facilities, and personnel are available. He nodded and smiled
in apparent agreement.
After lunch, we made the rounds of media interviews -- first ABC, and then NBC, CBS, CNN, CBC, and the New York Times with
Larry Altman. Since the patient was doing so well, they all found it difficult to ask controversial or critical questions.
They said that other physicians and surgeons they consulted told them that a 7-hour operation was too long and suggested that
there were some complications (actually, the entire anesthetic time was 5 hours -- and the aortic occlusion time during the
5 bypasses was only 68 minutes). They were also told that having 5 bypasses presaged a poor prognosis. I tried to correct
these erroneous facts and misinterpretations and emphasized the excellent early response (1st day) and that all the signs
indicated an excellent result from the operation and that he would return to full normal activity.
Thursday, November 7, 1996
Breakfast at 8 am and then to the Cardiology Research Center to meet with Chazov, Akchurin, and Lepilin. We were told that
all vital signs were satisfactory. He had been given 2 units of blood (transfusion) and his Hg and hemocrit were almost normal.
An x-ray of the chest showed a slight enlargement of the heart shadow, as compared with the previous day, but they were not
comparable, since this latest x-ray was taken in the prone position. I suggested that another x-ray should be made in the
upright position, since I was concerned that there may be fluid in the pericardium.
We were then told that President Yeltsin had announced that he would leave today at 2 pm for the Central Hospital. Dr. Chazov,
Lepilin, and Akchurin all agreed with me that this was undesirable and asked me to try to dissuade the President. I went
with them to the recovery room to see the President. He greeted us warmly and thanked us. I told him that it was important
for him to remain in this recovery room for another day, since this was the most critical period. I emphasized that he was
progressing well and that we did not want to take any risks. He finally agreed to stay another day. I then talked with Mrs.
Yeltsin and she also agreed that he should stay.
After lunch, I had an interview with the Wall Street Journal and with a Spanish T.V. reporter.
In the evening, we were treated to a lovely concert at the Barvija. There were musicians playing different sizes of Russian
guitars. They were obviously talented and played with great flair and fingering virtuoso.
We then had dinner with Professor Mironov, Akchurin, Lepilin, and our entire team.
Friday, November 8. 1996
Breakfast at 8 am and then to the Cardiology Research Center to meet with Chazov, Akchurin, and Lepilin who reported President
Yeltsin was progressing well with good vital signs: BP 120/70, Hb 12.8, Hemocrit 35, RBC 3.9 million. He had been walking,
taking fluids by mouth, and had a bowel movement. X-ray of the chest (upright) was clear, with no evidence of widening of
the heart shadow.
We agreed that he could be moved to the Central Clinic Hospital, as we promised
I then went into the recovery room with the other physicians and greeted the President and informed him that all vital signs
were good, and, as we promised yesterday, he could move to the Central Clinic Hospital. He smiled and thanked us. He planned
to leave at 11 am.
We had lunch at the new Gas Prom Center in Moscow after being shown various aspects of the building. It is of modem construction,
rather attractive with many atria. There is much marble, very plush carpets and other furnishings, with state of the art administrative
and computerized facilities. The entire distribution of gas throughout Russia and much of Europe is monitored from this Center.
We were told that Gas Prom employs 370, 000 people. In this Center, there is a medical clinic, which is only for outpatients,
and there are 70 physicians and 300 employees. Their daily census is 600 outpatient visits. They are planning on building
a hospital nearby of about 700 beds.
In the evening, we went to dinner at the home of Professor and Mrs. Mironov. It was delightful. Mrs. Mironov is a gracious
hostess. She is Georgian and proud of it. She sang a love song for us that she said goes back to the 17th century. They presented
me with a typical Georgian drinking horn.
Saturday, November 6, 1996
Following breakfast, we went to the Central Clinic at 9 am and were disappointed to find that Professor Mironov and the Russian
Surgical and Medical teams were not present. There was some misunderstanding about the time of the meeting, so we were given
a brief tour of the hospital and some information about its activities. They stated that 30% of the patients are foreigners.
They do about 3 or 4 coronary caths per day, but no cardiovascular surgery. They are planning to build an addition to the
hospital for this purpose. They now have 1,360 beds for general and medical use.
About 10:30 am the Russian team arrived, including Drs. Chazov and Akchurin, and we were given a report: BP 110/70, Pulse
80, sinus rhythm. The patient was having only slight discomfort. Hb 10.4, Hemocrit 29, RBC 3.4 million, Platelets 158, 000,
BKN and Creatine - normal. The patient is now taking nourishment well and has been strolling. He feels good and is doing some
We then went to the Kremlin for lunch with Mrs. Yeltsin and her daughters, Tatayana and Iliana (Helen), and Prime Minister
Chernomyrdin. I was seated at the head table next to Mrs. Yeltsin on one side and Chernomyrdin on the other. Dr. Akchurin
sat next to Mrs. Yeltsin on the other side. She gave the first toast to thank the doctors, including me and Dr. Akchurin.
I gave the third toast after Chernomyrdin. The luncheon was in the Nun Room in the Palace, which was built in the 11th century,
and the paintings on the wall and ceiling are about venerated nuns in the Orthodox Church. One of the most important nuns
and most loved by the Russian people is named Olga, and there is a large painting of her on one of the walls. Other toasts
included that by Chernomyrdin thanking me and my team. When we departed, Mrs. Yeltsin gave me the typical kiss (3 times) and
stated that I would always be welcomed by the Yeltsins.
After lunch, we had an interview at CNN and another at the No. 1 Russian Television.
Dr. Artsibashev gave a special going away dinner for our American medical team with great warmth and friendship. We were then
told we must leave for the airport at 5 am in order to board our plane to return home.
Sunday, November 10, 1996
Left the Barvija at 5: 15 am and arrived at the airport at 6 am. We were placed in the VIP Lounge, and our passports, tickets,
and boarding passes were given to us. I was given a first class seat, and the others were placed in business class on Aeroflot
The four-hour flight to Paris was uneventful, and we arrived at 9:30 am. We were met by a friendly hostess, who made convenient
arrangements to take us by bus from the plane to Terminal 2, where we boarded Air France No. 036. Again I was given a first
class seat. The flight to Houston was uneventful, arriving at 2:30 pm.