This meta-analysis evaluates the safety and effectiveness of direct aortic cannulation (AoC) versus peripheral cannulation (PC) in patients undergoing surgery for acute type A aortic dissection. Analyzing 10 retrospective studies involving 2518 patients, it found no significant differences in short-term mortality, stroke, or acute kidney injury between the two methods. However, AoC was associated with shorter operation times, suggesting it could be a viable alternative to PC, offering comparable outcomes with potential operational advantages.