Anastomosis of the outflow cannula to the descending aorta in a HeartWare left ventricular assist device.

We report a case in which a recipient of a HeartWare® HVAD left ventricular assist device (HeartWare, Framingham, MA, USA) was unable to undergo standard outflow graft anastomosis to the ascending aorta due to severe aortic calcification. The outflow graft of the device was instead anastomosed to the descending aorta. <Learning objective: Not all left ventricular assist device (LVAD) patients are candidates for outflow graft anastomosis to the ascending aorta. We report a case in which a HeartWare LVAD outflow graft was anastomosed to the descending aorta. We review this approach described in other contemporary devices and animal models. We include reports on device explant and exchange.>.