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Background: It is controversial whether peripheral arterial cannulation may achieve better results than direct aortic cannulation during surgery for Stanford type A aortic dissection., Methods: From January 2005 to December 2017, 309 consecutive patients underwent surgical repair for acute type A aortic dissection at Helsinki University Hospital, Finland. The early outcomes of patients who underwent surgery with direct aortic cannulation were compared with those of patients in whom peripheral arterial cannulation was used., Results: Direct aortic cannulation was used in 80 patients and peripheral arterial cannulation in 229 patients. Patients who underwent surgery with direct aortic cannulation had hospital mortality (13.8% vs 13.5%, P = .962) and stroke/global brain ischemia (22.3% vs 25%, P = .617) similar to that of patients who had peripheral arterial cannulation. The other secondary outcomes were equally distributed between the unmatched study cohorts. Among 74 propensity score matched pairs, direct aortic cannulation had hospital mortality rates (12.2% vs 9.5%, P = .804) and stroke/global brain ischemia rates (21.6% vs 21.6%, P = 1.000) comparable to those for peripheral arterial cannulation. The composite outcome of hospital mortality/stroke/global brain ischemia (29.7% vs 27%, P = .855), multiple stroke (16.2% vs 17.6%, P = 1.000), renal replacement therapy (11.8% vs 13%, P = 1.000) and length of stay in the intensive care unit (mean, 4.9 ± 4.5 vs 4.8 ± 4.9 days, P = .943) were also equally distributed between these matched cohorts., Conclusions: In this institutional series, central arterial cannulation allowed a straightforward surgical repair of type A aortic dissection and achieved early outcomes similar to those of peripheral arterial cannulation., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)