Preoperative evaluation and set-up:
If the patient is hemodynamically stable, we prefer to have a
preoperative cardiac gated CT angiogram of the chest, abdomen and pelvis
to clearly delineate the anatomy of the aorta, extent of dissection and
true and false lumen orientation. Otherwise, a hemodynamically unstable
patient is wheeled straight into the operating room and TEE is used to
provide us with relevant anatomical inputs. A right radial and femoral
arterial line is placed to assess for proximal and lower body perfusion
during bypass and after repair.