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Intraoperative dissection and late ascending aortic dissection and aneurysm formation infrequently complicate cardiac operations but remain a significant source of morbidity and mortality. A review of 11,145 consecutive cardiac operations at Emory University from January, 1982 through December, 1988 yielded 27 patients with an intraoperative ascending aortic dissection (incidence 0.24%) occurring at the time of the original procedure, with a hospital mortality of 14.8%. Nine additional patients with ascending aortic dissection or aneurysm, presenting late after a previous cardiac operation, were treated during this same period with three deaths. The technical aspects and decision making for application of closed aortic plication, open aortic reconstruction, and ascending aortic replacement based directly on the extent of the intraoperative dissection is detailed. An individualized technical approach tailored to the pathology encountered is outlined for the reoperative group of patients. Etiology, risk factors, principles of prevention, and indications for operation are also discussed.