Cook pasta according to package directions; drain, reserving 1/2 cup pasta cooking water.
Heat olive oil in a large high-sided skillet over medium-high. Add sausage and mushrooms and cook, stirring occasionally, until browned, about 6 minutes. Remove to a plate; carefully wipe the skillet clean as it may be hot.
Melt butter in the same skillet over medium heat; cook garlic in hot butter, stirring occasionally, until garlic just begins to brown, 2 to 3 minutes. Add half-and-half and cream cheese; bring to a simmer, whisking constantly until smooth.
Remove the skillet from heat. Stir in 3/4 cup Parmesan cheese, salt, and pepper until smooth. Add pasta and sausage mixture; toss to coat. Thin sauce with reserved pasta water if necessary.
Serve in shallow bowls topped with pesto, basil, and remaining 1/4 cup Parmesan cheese.
Nutritional Facts
Per 4 servings
Calories: 1023
Carbohydrate: 57g
Fat: 73g
Fiber: 6g
Protein: 38g
Sugar: 3g
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