Traditional implantation of left ventricular assist device (LVAD) via median sternotomy can pose significant risks in patients with previous sternotomies. We present a patient with history of multiple cardiac surgeries through median sternotomies now needing LVAD support. To avoid re-entry injury, a HeartMate 3 LVAD was implanted via left thoracotomy with outflow graft anastomosis to the descending thoracic aorta, an unconventional but safe alternative approach to LVAD implantation.