A clinical and economic assessment of adjuvanted trivalent versus standard egg-derived quadrivalent influenza vaccines among older adults in the United States during the 2018-19 and 2019-20 influenza seasons.

BACKGROUND: Clinical evidence supports use of enhanced influenza vaccines in older adults. Few economic outcome studies have compared adjuvanted trivalent inactivated (aIIV3) and standard egg-derived quadrivalent inactivated influenza vaccines (IIV4e). RESEARCH DESIGN AND METHODS: A retrospective cohort study was conducted leveraging deidentified US hospital data linked to claims data during the 2018-19 and 2019-20 influenza seasons. Relative vaccine effectiveness (rVE) was compared in adults aged ≥ 65 years receiving aIIV3 or IIV4e using inverse probability of treatment weighting (IPTW) and Poisson regression. An economic assessment quantified potential real-world cost savings. RESULTS: The study included 715,807 aIIV3 and 320,991 IIV4e recipients in the 2018-19 and 844,169 aIIV3 and 306,270 IIV4e recipients in the 2019-20 influenza seasons. aIIV3 was significantly more effective than IIV4e in preventing cardiorespiratory disease (2018-19 rVE = 6.2%; and 2019-20 rVE = 6.0%) and respiratory disease (2018-19 rVE = 8.9%; and 2019-20 rVE = 10.1%). During the 2018-19 influenza season cardiorespiratory hospitalization cost savings for the aIIV3 population were $392 M, and $221 M for the 2019-20 season. Respiratory hospitalization cost savings for the aIIV3 population were $145 M and $97 M, respectively. CONCLUSIONS: Our findings suggest that aIIV3 provides clinical and economic advantages versus IIV4e in the elderly.

Flu vaccines do not work as well in older adults due to the aging of their immune system. One approach to improving vaccine efficacy is the addition of a substance, or adjuvant, to the vaccine in order to boost an individual's immune response. This study evaluated an adjuvanted vaccine compared to an unadjuvanted vaccine for preventing cardiorespiratory hospitalizations and hospitalization costs. The findings demonstrated that the adjuvanted flu vaccine, compared to the unadjuvanted vaccine, prevented more hospitalizations and greatly reduced associated hospital costs.

Awareness, attitudes, and practices on meningococcal serogroup B vaccination in the United States among parents of older adolescents and among young adults.

OBJECTIVE: Meningococcal serogroup B (MenB) vaccination is recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and young adults 16-23-years-old under shared clinical decision-making (SCDM). However, MenB vaccination coverage in this population remains low in the United States (US). We investigated the awareness, attitudes, and practices regarding MenB disease and vaccination among parents of 16-18-year-old older adolescents and among 19-23-year-old young adults. METHODS: An online survey was conducted in September-October 2022 among parents of older adolescents and among young adults recruited from a US-based patient panel. RESULTS: There were 606 total participants, including parents of MenB-vaccinated (n = 151) and non-vaccinated (n = 154) adolescents, and also MenB-vaccinated (n = 150) and non-vaccinated (n = 151) young adults. Non-vaccinated cohorts reported low awareness of MenB disease (58.3-67.5%) and vaccination (49.7-61.0%), though awareness was higher among non-vaccinated parents. However, all cohorts reported high interest in learning more about MenB disease and vaccination. Vaccinated cohorts relied on primary care providers (PCPs) to initiate MenB vaccination conversation and had a low awareness of SCDM at 35.1-45.3%, though those aware of SCDM were more likely to participate in decision-making. Barriers to MenB vaccination included lack of PCP recommendation, vaccine side effects, and uncertainty about vaccination need. CONCLUSIONS: There are gaps in awareness of MenB disease, vaccination, and SCDM among parents and patients in the US, resulting in missed opportunities for discussing and administering MenB vaccination. Targeted education on MenB and vaccination recommendations may increase these opportunities and improve MenB vaccination awareness and initiation.

MenB disease, a type of meningitis, is a serious and life-threatening illness. The US Centers for Disease Control and Prevention (CDC) recommends that 16­23-year-olds get a MenB vaccine after talking with their healthcare provider and deciding it is the right choice. As of 2021, only about 3 in 10 17-year-olds had received a MenB vaccine. In this study, we used an online survey to learn about parents of older teens' (16­18-years-old) and young adults' (19­23-years-old) awareness, thoughts, and practices related to meningitis and the MenB vaccine. Parents of non-vaccinated teens, and non-vaccinated young adults, had a lower awareness of the causes, risks, and symptoms of meningitis, and the MenB vaccine. In addition, most parents thought the impact of meningitis would be severe, compared with young adults who thought it would be less severe. Most participants were also not aware of their role in deciding if they or their child should be vaccinated against MenB. However, most showed a high interest in learning more about meningitis and the MenB vaccine. We also found that most teens and young adults who did receive the MenB vaccine received it right after talking about it with their healthcare provider. These findings show a clear opportunity to address gaps in awareness and thoughts about meningitis and MenB vaccination. Providing education and resources to parents, young adults, and healthcare providers could create more opportunities to discuss MenB vaccination and lead to more teens and young adults accessing vaccination and being protected against meningitis.

Geographic variation in disease burden among patients with severe persistent asthma in the United States.

BACKGROUND: In the United States, a few studies have evaluated geographic variation of severe asthma at the subnational level. OBJECTIVE: To assess state-level geographic variation in the prevalence and characteristics of severe persistent asthma in the United States. METHODS: Patients aged above or equal to 12 years with severe persistent asthma were identified using nationally representative data from IQVIA open-source Medical/Pharmacy Claims and PharMetrics Plus databases (January 2019-December 2020). The index date was defined as the patient's earliest qualifying date for a severe asthma diagnosis. Baseline characteristics were measured during the 12-month pre-index period. Outcomes including exacerbation occurrence, asthma control, and medication use were measured during the 12-month post-index period and compared across states using census-level projections. RESULTS: A total of 2,092,799 patients with asthma were identified; 496,750 (23.7%) met criteria for severe persistent asthma and all inclusion criteria. Mean age was 50.5 years; 68.4% were females. The prevalence of severe persistent asthma varied across states, ranging from 19.6% (New Mexico) to 31.9% (Alaska). Among patients with severe persistent asthma, 40.9% had more than or equal to 1 exacerbation, ranging from 34.2% (Vermont) to 45.6% (Louisiana); 21.1% had uncontrolled disease, ranging from 16.5% (Vermont) to 24.0% (Arizona). Among patients with exacerbations, 13.7% had exacerbation-related emergency department visits or hospitalizations, ranging from 7.0% (North Carolina) to 17.7% (Nevada). Among patients with severe uncontrolled asthma, 15.6% used biologics post-index, ranging from 2.2% (Hawaii) to 27.9% (Mississippi). CONCLUSION: There is significant variability in severe persistent asthma prevalence and disease burden across US states. Reasons for geographic variation may include differences in socioeconomic/environmental factors or asthma management.

Real-World Systemic Treatment Patterns after Atezolizumab and Bevacizumab in Patients with Hepatocellular Carcinoma in the United States.

Real-world (RW) evidence is needed to evaluate atezolizumab plus bevacizumab (atezo + bev) utilization for hepatocellular carcinoma (HCC) in clinical practice. This retrospective cohort study used administrative claims databases to evaluate treatment patterns in individuals with HCC ≥18 years of age who were initiated on atezo + bev between June 2020 and June 2022. The endpoints of this study were the proportion of individuals who discontinued atezo + bev and received subsequent systemic therapies, time to discontinuation (TTD), and time to next treatment. Overall, 825 individuals were eligible (median age 67 years; 80% male). Over a median follow-up of 15.3 months, most (72%) discontinued atezo + bev, with a median TTD of 3.5 months. A minority (19%) received subsequent therapies, with the most common second-line agents being lenvatinib (6%), cabozantinib (4%), and nivolumab (4%). The median time from index to next treatment post-atezo + bev was 5.4 months. Further research is needed to identify the patients who are most likely to benefit from atezo + bev as well as later-line HCC therapies to optimize overall survival.

Single-pumped gain profile for a superluminal ring laser.

We present an approach for realizing a superluminal ring laser using a single isotope of atomic Rb vapor by producing electromagnetically induced transparency (EIT) in self-pumped Raman gain. Only a single pump laser is used for generating a Raman gain profile containing a dip at its center. The position and depth of this dip can be tuned by adjusting the intensity of the pump laser, allowing for optimizing the degree of enhancement in sensitivity within a certain operating range. This approach represents a significant simplification of the design of superluminal lasers compared to the approaches demonstrated in previous studies. We demonstrate experimentally the realization of this scheme using transitions within the D1 and the D2 manifolds of 85Rb. Numerical simulations based on an approximate model show close agreement with the experimental results.

Treatment patterns for patients initiating novel acute migraine specific medications (nAMSMs) in the context of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway.

BACKGROUND: New acute and preventive migraine medications are available, but data on current treatment patterns are limited. This study describes migraine treatment patterns among patients initiating novel acute migraine specific medications (nAMSMs), overall and by prior use of anti-calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies (mAbs). METHODS: In this retrospective cohort study using IQVIA open-source pharmacy and medical claims data, we identified patients with ≥ 1 claim for a nAMSM (ubrogepant, rimegepant, lasmiditan) between 01/01/2020 and 09/30/2020 (index period). Patients were indexed on their first nAMSM claim and stratified into 2 cohorts: patients with prior mAb use (≥ 1 claim for erenumab, fremanezumab, galcanezumab in the 6-month pre-index period) or patients without prior mAb use. Treatment patterns were assessed during the 6-month post-index period. RESULTS: Overall, 78,574 patients were identified (63% indexed on ubrogepant, 34% on rimegepant, and 3% on lasmiditan) with 26,656 patients (34%) having had prior mAb use. In the pre-index period, 79% of patients used non-mAb preventive medications and 75% of patients used acute medications. Following the index nAMSM claim, 65% of patients had ≥ 1 refill and 21% had ≥ 4 refills of their index nAMSM; 10% of patients switched to another nAMSM. Post-index mAb use was observed in 82% of patients with a prior mAb and 15% of patients without. Among patients with pre- and post-index use of acute medications, 38% discontinued ≥ 1 acute medication class in the post-index period. Among patients with concomitant use of traditional preventive medications at index, 30% discontinued ≥ 1 concomitant preventive anti-migraine medication in the post-index period. CONCLUSIONS: Most patients initiating nAMSMs had prior treatment with acute and preventive medications. Approximately one-third of patients had prior treatment with anti-CGRP pathway mAbs. After starting nAMSMs, more than one-third of patients discontinued at least one traditional acute medication and one-third of patients discontinued at least one traditional preventive medication. Despite nAMSM initiation, most patients with prior anti-CGRP pathway mAb use continued mAb use. Around 15% of patients without a prior mAb newly started a mAb. These results provide insight into how nAMSMs and mAbs have been integrated into clinical management of migraine in the real-world.

Real-world use of ofatumumab to treat multiple sclerosis 9 months post-FDA approval during COVID-19 pandemic.

BACKGROUND: Relapsing multiple sclerosis (MS) is an inflammatory, demyelinating, neurodegenerative disease of the central nervous system that causes episodes of neurological dysfunction (relapse) alternating with variable intervals of stability. Disease-modifying therapies (DMTs) aim to reduce the rate of relapse and slow disease progression in people with MS, particularly in those with relapsing MS. Ofatumumab is a fully human anti-CD20 monoclonal antibody approved to treat patients with relapsing forms of MS. This study describes the demographics, clinical characteristics, and prior DMT use of patients with at least one ofatumumab prescription claim following approval by the United States (US) Food and Drug Administration (FDA). Understanding ofatumumab utilization patterns and patient characteristics can help define the journey of patients with MS and aid future clinical decision-making. METHODS: This retrospective study is based on data from IQVIA's Longitudinal Prescription Data (LRx) and Medical Claims (Dx) databases in the US, collected between August 01, 2019 and May 31, 2021. The index date was defined as the date of the first ofatumumab prescription. The pre-index period was defined as the 12 months prior to the index date. Adult patients (aged ≥18 years) with a diagnosis of MS and at least one prescription for ofatumumab between August 2020 and May 2021 in the LRx database were included. Only patients with at least one medical claim in the Dx database and a diagnosis of MS 24 months prior to the index date were included. Descriptive analyses were conducted 3, 6, and 9 months after FDA approval. RESULTS: Overall, 3,600 patients with a prescription for ofatumumab were identified in the LRx claims database, and 2,101 patients remained in the study after inclusion and exclusion criteria had been applied. At the 9-month post-approval time point, patients with ofatumumab claims were characterized as primarily female (74%) and middle-aged (median age: 48 years); two-thirds (64.7%) had a mild MS disability level. Patients were otherwise generally healthy with limited comorbid conditions. Most patients (81.7%) in the study did not experience relapse during the pre-index period. DMT-naïve patients who were prescribed ofatumumab at 3, 6, and 9 months post-approval accounted for 46.9%, 54.8%, and 58.4% of the study population, respectively. Over time, this increase in DMT-naïve ofatumumab initiators was statistically significant (p = 0.0003). Among patients who had been treated with DMTs during the previous year, most had taken them orally (50.6%), some had received them via intravenous infusion (32.2%), and some via subcutaneous/intramuscular injection (21.1%). Intravenous ocrelizumab was the most common DMT switch observed (n = 205, 23.4%) among these patients. CONCLUSION: This real-world study is the first to describe patients treated with ofatumumab since FDA approval during the COVID-19 pandemic. The majority of patients in this study were middle-aged women with mild MS symptoms. Ofatumumab was increasingly used as a first-line DMT. Additionally, a number of patients aged ≥55 years (beyond the trial population) used ofatumumab, which may suggest expanding clinician confidence in the safety and clinical utility of ofatumumab therapy. However, future long-term observational studies are needed to confirm these results.

Demonstration of a superluminal laser using electromagnetically induced transparency in Raman gain.

We report the realization of a superluminal laser in which the dip in the gain profile necessary for anomalous dispersion is produced via electromagnetically induced transparency caused by the optical pumping laser. This laser also creates the ground state population inversion necessary for generating Raman gain. Compared to a conventional Raman laser with similar operating parameters but without the dip in the gain profile, the spectral sensitivity of this approach is explicitly demonstrated to be enhanced by a factor of ∼12.7. Compared to an empty cavity, the peak value of the sensitivity enhancement factor under optimal operation parameters is inferred to be ∼360.

Observation of a highly superluminal laser employing optically pumped Raman gain and depletion.

In this paper, we report a Raman laser which is extremely sensitive to a variation of the cavity length, using a scheme employing two stable isotopes of Rb. One isotope is used for producing a broad gain spectrum via the optically pumped Raman gain process, while the other is used for producing a narrow dip via the optically pumped Raman depletion process. By tuning the frequencies of the two Raman pumps, the center frequencies of the gain and dip can be aligned to the same frequency. This approach allows tuning of the gain and dip parameters independently over a broad range of operating conditions. With such a configuration, we can produce a negative dispersion around the two-photon resonance frequency in the vapor cell, which leads to a group index that is close to zero. By theoretically matching the experimental observations, we can infer that the sensitivity of such laser is enhanced by a factor of more than 2800, which is nearly a factor of three larger than the highest value reported previously using a different approach.

Electromagnetically induced transparency in Raman gain for realizing a superluminal ring laser.

We describe an approach for realizing a superluminal ring laser using a single isotope of Rb vapor by producing electromagnetically induced transparency (EIT) in Raman gain. We show that by modifying the detuning and the intensity of the optical pump field used for generating the two-photon population inversion needed for generating Raman gain, it is possible to generate a dip in the center of the gain profile that can be tuned to produce a vanishingly small group index, as needed for making the Raman laser superluminal. We show that two such lasers, employing two different vapor cells, can be realized simultaneously, operating in counter-propagating directions in the same cavity, as needed for realizing a superluminal ring laser gyroscope. This technique, employing only one isotope, is much simpler than the earlier, alternative approach for realizing a superluminal Raman laser based on Raman gain and Raman dip in two isotopes [Zhou et. al, Opt. Express27, 29738 (2019)10.1364/OE.27.029738]. We present both an approximate theoretical model based on four levels as well as the results of a model that takes into account all relevant hyperfine states corresponding to the D1 and D2 transitions in 85Rb atom. We also present experimental results, in good agreement with the theoretical model, to validate the approach.

Phase correlation during two-photon resonance process in an active cavity.

In this paper, we experimentally demonstrate a strong correlation between the frequencies of the Raman pump and the Raman probe inside an optically pumped Raman laser. We show that the correlation is due to rapid adjustment of the phase of the dipoles that produce the Raman gain, following a sudden jump in the phase of the Raman pump. A detailed numerical model validates this interpretation of the phase correlation. The width of the spectrum of the beat between the Raman pump and the Raman laser is significantly narrowed due to this correlation. As a result, the minimum measurable change in the cavity length, for a given linewidth of the Raman pump laser, is substantially reduced. Therefore, this finding is expected to enhance the sensitivity of such a laser in various metrological applications (e.g., accelerometry).

Superluminal Raman laser with enhanced cavity length sensitivity.

We demonstrate experimentally a superluminal ring laser based on optically pumped Raman gain, and a self-pumped Raman depletion for producing anomalous dispersion, employing two isotopes of rubidium. By fitting the experiment data with the theoretical model, we infer that the spectral sensitivity of the superluminal Raman laser to cavity length change is enhanced by a factor of more than a thousand, compared to a conventional laser.

Prediction of storage modulus in solid-like poly (lactic acid)/poly (ethylene oxide)/carbon nanotubes nanocomposites assuming the contributions of nanoparticles and interphase regions in the networks.

In this paper, Kolarik model for tensile modulus of co-continuous blends is developed to predict the storage modulus of poly (lactic acid) (PLA)/poly (ethylene oxide) (PEO)/carbon nanotubes (CNT) nanocomposites at low frequencies (solid-like region). The storage moduli of prepared samples are obtained by frequency sweep test and Kolarik model is expanded assuming the characteristics of interphase regions and CNT networks. The developed model takes into account the percolation threshold, the percentage of networked CNT and the volume fraction of interphase regions in the networks. The calculations of developed model are compared to the experimental data and the significances of main parameters on the storage modulus are justified. The calculations successfully agree with the experimental data at different PLA and CNT concentrations. The addition of CNT thickens and strengthens the interphase regions in the samples, but the different concentrations of PLA differently affect the properties of interphase regions. A thick and strong interphase enhances the storage modulus of nanocomposites. The high fraction of networked CNT and the significant modulus of nanoparticles considerably promote the storage modulus, but only small networks cause poor storage modulus for nanocomposites.

Demonstration of a highly subluminal laser with suppression of cavity length sensitivity by nearly three orders of magnitude.

We have demonstrated a laser in which the frequency shift due to small cavity fluctuations is far less than what would be expected from a conventional laser. The factor of sensitivity suppression is inferred to be equal to the effective group index experienced by the laser, implying that this laser is subluminal. We have observed a suppression factor as high as 663. Such a laser is highly self-stabilized compared to a conventional laser, and is expected to have a far smaller Schawlow-Townes linewidth. As a result, this laser may have potentially significant applications in the fields of high-precision optical metrology and passive frequency stabilization.

Theoretical modeling and experimental demonstration of Raman probe induced spectral dip for realizing a superluminal laser.

We have demonstrated experimentally a Diode-Pumped Alkali Laser (DPAL) with a Raman resonance induced dip in the center of the gain profile, in order to produce an anomalous dispersion, necessary for making the laser superluminal. Numerical calculations match closely with experimental results, and indicate that the laser is operating superluminally, with the group index far below unity (~0.00526) at the center of the dip. The estimated factor of enhancement in the sensitivity to cavity length perturbation is ~190, approximately equaling the inverse of the group index. This enhancement factor can be made much higher via optimal tuning of parameters. Such a laser has the potential to advance significantly the field of high-precision metrology, with applications such as vibrometry, accelerometry, and rotation sensing.

Aortic Root Wrapped Procedure for Treating Aortic Root Sinus Aneurysm.

BACKGROUND: To develop a relatively simple and effective and low-risk operation, aortic root wrapped procedure, to treat aortic root aneurysm or ectasia. METHODS: From June 2008 to September 2010, 15 patients were accepted for aortic root wrapped angioplasty procedure, Marfan's syndrome with aortic root ectasia in 2 cases, and aortic sinus aneurysm with middle to severe aortic valve stenosis and/or regurgitation in 13 cases. The diameter of aortic valve annulus was 25.43 ± 2.34 mm (range = 22-32 mm) and the diameter of aortic sinus was 50.45 ± 7.32 mm (range = 45-60 mm). All patients underwent aortic root wrapped angioplasty procedures with artificial blood vessel combined with aortic valve plasty or replacement with tissue valve prosthesis. RESULTS: Fifteen patients survived well, and the perioperative mortality was 0%. Cardiopulmonary bypass time was 82.31 ± 16.34 minutes (range = 55-128 minutes). Predischarge echocardiography check result showed trace aortic regurgitation in 3 cases and normal aortic valve function in 12 cases. Compared with preoperative echocardiography results, the aortic annulus diameter (22.63 ± 1.25 mm [range = 21-25 mm]) decreased significantly (P < .01) and the aortic sinus diameter (36.86 ± 7.41 mm [range = 30-41 mm]) decreased significantly (P < .001). Follow-up results: All 15 patients survived well, and heart function (New York Heart Association classification) of the patients are all class I. The late mortality was 0%. CONCLUSION: Aortic root wrapped procedures combined with aortic valve plastic or replacement operation is an alternative surgical procedure in patients with aortic sinus aneurysm and aortic valve disease.

Mosaic tissue-engineered porcine pulmonary artery valved conduit: long-term follow-up after implantation in an ovine model.

OBJECTIVES: To determine the effects of implanting a novel mosaic tissue-engineered porcine pulmonary artery valved conduit into the right ventricular outflow tract of sheep at a long-term follow-up. METHODS: The designed mosaic tissue-engineered porcine pulmonary artery valved conduits were implanted between the right ventricular outflow tract and distal pulmonary artery in sheep using the off-pump method. The sheep weight, conduit diameter, pulmonary valve annular diameter, left ventricular end-diastolic diameter, calcification and regurgitation of the pulmonary valve were measured preoperatively and at 6 and 12 months postoperatively. Macroscopic observation, ultrastructural analysis, endothelialization and detection of calcium content were performed after sacrificing the sheep at 12 months after surgery. RESULTS: The average sheep weight at 12 months after surgery was significantly higher than that preoperatively (P <0.05), indicating that the sheep continued to grow well. The transplanted conduit showed unobstructed blood flow, soft walls and a smooth inner wall, but no ectasia or stenosis. The valve of the conduit was partially stiff, able to open and close and mild-to-medium regurgitation was present. The conduit diameter, pulmonary valve annular diameter and the left ventricular end-diastolic diameter were each significantly increased (P <0.05). Haematoxylin-eosin staining and scanning electron microscopy revealed regularly arranged cells with slight inflammatory cell infiltration and a clear, fibrous texture. Immunohistochemical staining indicated that endothelial cell marker CD31-positive cells had formed a continuous film-like structure on the inner wall of the conduit. Scattered smooth muscle actin-positive cells were found in the middle layer of the conduit. CONCLUSIONS: The mosaic tissue-engineered porcine pulmonary artery valved conduit demonstrated good biocompatibility, did not cause an immune rejection response, contributed to endothelial coverage and has the potential to adapt to the needs of the growth and development of the body.

[Research progress of skeletal myoblasts for cardiac repair].

OBJECTIVE: To review the recent research progress of skeletal myoblasts for cardiac repair. METHODS: The related literature about skeletal myoblasts for cardiac repair was reviewed, analyzed, and summarized. RESULTS: The results of animal experiments and clinical studies have shown that skeletal myoblasts been transplanted into the regional myocardial infarction area in different ways can improve cardiac function. But there are some challenges such as high loss rate of skeletal myoblasts and resulting in ventricular arrhythmias. CONCLUSION: Further studies can improve the safety and effectiveness of skeletal myoblasts for cardiac repair in the future.

Long-term results of surgical treatment of aortic and mitral regurgitation with enlarged left ventricle.

Mitral valve and aortic valve regurgitation associated with enlarged left ventricle remains difficult to manage and the long-term results following surgical treatment is uncertain. Between April 1988 and September 2000, 82 patients with aortic and mitral regurgitation associated with enlarged left ventricle underwent valve replacement at Anzhen Hospital. The valve disease was rheumatic in origin in 75 patients (91.5%) and congenital in 7 (8.5%). Twenty-eight patients were in New York heart Association Functional (NYHA) class II and 39 in class III and 15 in class IV. Echocardiogram showed severe aortic insufficiency associated with mild to moderate mitral regurgitation in 66 patients and severe mitral regurgitation associated with mild to moderate AI in 16 patients. The mean left ventricular diastole diameter (LVDD) was 77.8 ± 5.2 mm. Valve replacement was performed under hypothermic cardiopulmonary bypass (CPB). Early hospital mortality was 7.3%. Two weeks after surgery the echocardiogram showed a reduction of LVDD. Follow up was completed in 69 patients with mean of 13.5 years. 20 patients were in NYHA class I; 26 in Class II and 3 in Class III and 2 in class IV. The follow-up survival rate was 73.9%, and follow-up mortality was 26.1%. LVDD reduced from 77.8 ± 5.2 mm to 58.3 ± 4.5 mm (P < 0.001). In 24 patients, the LVDD was less than 50 mm. Double valve replacement and/or repair carried out an acceptable early and Long-term clinical outcomes in patients with MR and AI with associated LV great enlargement. Both LVDD and NYHA improved following surgical treatment in survival patients.