OBJECTIVES Acute aortic dissection type A (AADA) is still an emergency operation with high morbidity and mortality. In this acute situation quick cannulation to the heart-lung machine and systemic cooling is often life-saving. However, the often easy access to the femoral vessels for cannulation leads to an arterial backflow in the descending aorta with the likelihood of plaque rupture and cerebral embolism. We analysed the outcome after initial femoral versus central cannulation for AADA. METHODS All patients with acute aortic dissection type A operated between January 2003 and December 2012 were evaluated for the type of arterial cannulation (femoral vs central) for initial bypass. Demographic data and outcome parameters were accessed. No patient was excluded. RESULTS One hundred and seventy-seven patients were operated on with acute type A dissection in the last 10 years; 94 (53.1%) were initially cannulated in the central aortic vessels and 83 (46.9%) in the femoral artery. The patients were comparable with regard to age (61.1 ± 14.9 vs 62.2 ± 15.0 years, P = 0.607), gender (male, 62 vs 69%, P = 0.348), EuroSCORE (11.5 ± 4.0 vs 12.8 ± 4.3, P = 0.057) and previous sternotomy (17% in both groups). Bypass (243 ± 105 vs 233 ± 83 min, P = 0.471), cross-clamp (160 ± 86 vs 150 ± 66 min, P = 0.381) and circulatory arrest times (47.8 ± 24.7 vs 42.5 ± 21.7 min, P = 0.130) were similar as were lowest temperatures (17.7 ± 1.8 vs 17.6 ± 1.3, P = 0.652). Postoperative cerebral infarction and 30-day mortality were comparable between the cannulation groups (13 vs 9%, P = 0.449 and 20 vs 17%, P = 0.699, central vs peripheral cannulation). Only postoperative need for dialysis was borderline significantly higher in the femoral cannulation group (28 vs 40%, P = 0.073). CONCLUSIONS This single-centre study with 177 patients could show that an acute aortic dissection type A can be operated on with central and peripheral cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and haemodynamic status before operation rather than the cannulation technique.