Paris Match. In what cases is one likely to propose a bypass heart surgery? 
Dr Gilles Dreyfus. In presence of an illness: the athérosclérose coronarienne where one observes a shrinkage in one or several coronary arteries risking to choke or close the artery.  The danger of a sharp closure, that is the coronary thrombosis, in some cases, can cause death. One knows well today the triggering factors of this illness: heredity, hypertension, obesity, tobacco addiction, the anomalies of cholesterol and diabetes.

P.M. What are the symptoms of this athérosclérose coronarienne and what exams allow you to discover it? 
Dr G.D. This illness is revealed most often by thoracic pains with effort or with rest. However, these pains can sometimes make one suspect a stomach ulcer or be localized elsewhere that in the thorax. In certain cases where the athérosclérose coronarienne is already evolved, panting can embarrass the patient (even in the absence of all pain). In other especially serious forms, the illness appears in a brutal way by a heart attack (closure by a clot of an arterial shrinkage preexisting or "unsteady" beating). 

P.M. When you discover the presence of one or several arterial shrinkages, in what cases do you recommend a bypass surgery? 
Dr G.D. The heart bypass surgery addresses most often the worst conditions, that means when it has reached several territories of the cardiac muscle there (or even of all territories) and in diffuse and multiple shrinkage cases on a same artery. But it is necessary to know that bypass surgery and angioplasty can complete themselves mutually. 

P.M. What does a heart bypass surgery consist of? 
Dr. G.D. It is not about removing the sick portion of the artery but doing a bridge, above the lesion, with a segment of artery or vein of the patient in order to bring oxygenated blood into the zone of the cardiac muscle that suffered for lack of oxygen. (The present tendency is to use arterial surrogates more than venous, because of better results long-term.)  There exists today two operative techniques to achieve these bypass surgeries: one is called "heart beating", because it takes place without circulating the blood outside the heart, and the other "heart stopped", because it requires circulation outside the body. Currently one achieves more bypass surgeries [of the simpler kind], except for the cases that require five and six bypasses!... And, in those cases, the harder operation between five and six hours. It is therefore a heavy surgery requiring about one week of hospitalization and a stop of the active life of three to four weeks. 

P.M. In general, what are the results of these multiple bypass surgeries? 
Dr G.D. In terms of survival, one can consider that the patients join the curve of life expectancy of a normal population (but under the stipulation that they control the associated risk factors). And, in some cases, one can even say that these bypass surgeries prolong the life expectancy! With regard to the other benefits of the heart bypass surgery, they are generally three: 1. Suppression of the pains. 2. Normalization of the irrigation of the cardiac muscle so that you recover a better functioning of the heart and disappearance of the panting. 3. Reduction for certain diseases of the risk of heart attack.

P.M. After one or several bypass surgeries, what are the constraints in the daily life? 
Dr. G.D. To stop smoking, to control the arterial hypertension by medicines, to return to a normal weight, to fight against cholesterol by a suitable régime, to take some statines [no idea] and to exercise regularly.  It is necessary to insist on the fact that while doing a bypass surgery one treats the insufficient heart during "one given instant" of the patient's illness. The multiplicity of the factors that generated this crisis is such that it can continue to evolve and to develop other lesions to the level of the heart or other organs (carotid, abdominal aorta). That's why it is necessary to put in work to decrease the impact of the risk factors... even though the patients, once recovered, feel completely healed.   
 
Dr Gilles Dreyfus is chief of the service of cardiovascular surgery of the Hôpital Foch in Suresnes. He asks us to specify that the answers to this interview are independent of the progress of intervention that he achieved on Gérard Depardieu.