We report the successful open repair of a thoracoabdominal aneurysm that had expanded after previous endovascular stenting. Aortic valve-sparing root replacement was performed as an initial step because the patient had significant aortic valve regurgitation caused by root enlargement. Continued aneurysmal dilatation after stenting of the thoracic aorta can lead to repair failure and therefore underscores the need for careful follow-up of patients after endografting.