Sandbox vidit

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

No

Yes

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

No

Medical management

Yes

❑ Age>40?

No

Yes

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

No

Yes

❑ Perform angiography Is significant CAD detected on angiography?

No

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