A patient with end-stage liver disease, aortic stenosis and rapid progression of an aortic root pseudo-aneurysm underwent successful combined heart-liver transplantation. A 56-year-old female with decompensated cirrhosis, severe aortic stenosis and an aortic root pseudo-aneurysm with strep bacteremia and aortic valve endocarditis. The pseudoaneurysm rapidly progressed with evidence of contained rupture. Due to operative risk posed by liver disease, the patient was evaluated and ultimately underwent heart-liver transplant. This case highlights the novel use of combined heart-liver transplant and demonstrates the safety of applying this therapy in patient's with prohibitive risk for conventional cardiac surgery.