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❑ Imaging study confirms aortic dissection ❑ Check whether dissection occurred in ascending aorta

Assess suitability for surgery Patient stable for pre-op testing?

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Yes

Age>40?

Yes

Assess need for pre-operative coronary angiography Known CAD? Significant risk factors for CAD?

Yes

Perform angiography Is significant CAD detected o angiography?

Yes

Plan for CABG at the time of aortic dissection repair

Perform urgent operative management

Perform intra-operative assessment of aortic valve by TEE for presence of one of the following: Aortic regurgitation Dissection of aortic sinuses

No

Yes

Perform graft replacement of ascending aorta ± aortic arch

Perform graft replacement of ascending aorta ± aortic arch Consider repair/replacement of aortic valve