A Hypertensive Man With Repaired Type A Aortic Dissection Presents With Enlarging Thoracic Aorta
A 59-year-old hypertensive male who had a repair of a type A aortic dissection 20 years ago is referred to you for an enlarging thoracic aorta. The patient is asymptomatic, but on routine follow-up with serial computed tomography (CT) imaging, his aortic root is now 5.6 cm, the chronically dissected arch is 5.8 cm, and he has an extent II thoracoabdominal aneurysm and dissection with a maximal diameter of 6.5 cm involving the entire descending and thoracoabdominal aorta. Transthoracic echocardiography reveals a dilated aortic root, moderate aortic insufficiency, left ventricular end-diastolic dimension 61 mm, and ejection fraction 55%. Coronary angiography shows non-obstructive coronary artery disease.
Which of the following statements describes the optimal next step in management for this patient's aortic disease?