We report a case of thoracoabdominal aneurysm repair in a 44-year-old man with end-stage heart failure requiring an extracorporeal left ventricular assist device (LVAD). At the age of 31 years, the patient experienced type B acute aortic dissection, which gradually dilated to a maximum dimension of 66 mm at the diaphragm. The aneurysm prevented the patient from meeting heart transplantation criteria. For this reason and because of an increased risk of rupture, we undertook surgical repair of the aneurysm. This report constitutes the first such published case, and we describe the management of the LVAD in the perioperative period.