Innominate artery cannulation is indicated mainly for surgery which involves aortic root and aortic arch when pathology precludes standard cannulation of the ascending aorta. Thus, it can be used as the procedure of choice in cases of ascending aortic aneurysm, type A aortic dissection, porcelain aorta and reoperation for coronary or aortic surgery. It is performed through a standard median sternotomy, hence avoiding the complications of a second incision. It provides antegrade systemic and cerebral flow that is associated with improved distal organ perfusion and reduced rate of retrograde cerebral embolization compared to femoral arterial cannulation, Moreover, it eliminates potential complications from axillary artery cannulation, such as dissection, upper extremity malperfusion and brachial plexus injury. It is contraindicated in cases of excessive calcification and acute dissection clearly involving the innominate artery.