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.