Type A aortic dissection most often requires emergent surgery to prevent malperfusion, stroke, and/or rupture of aorta. The conduct of the surgery is mostly targeted at restoring true lumen flow. In this regard, institution of cardiopulmonary bypass and circulation management is key to allow adequate systemic flow, perfusion of brain and visceral organs and comprehensive systemic cooling to achieve circulatory arrest when needed. Different strategies have been used with varying success rates, with the most common being femoral cannulation. More recently axillary and central cannulation strategies have shown satisfactory results with the promise of antegrade flow. Cannulation approach should, therefore, depend on individual patient characteristics, presentation and true lumen anatomy.