This retrospective review of outcomes after reconstruction of the intervalvular fibrous trigone combined with aortic and mitral valve replacement  tracked patients who were operated upon for either severe endocarditis (n=26) or severe calcification (n=14) involving the trigone.  The David Technique for reconstruction was used, and the operative mortality for these complex operations was 15% and 7%, respectively.  Despite high operative risk and complexity, the authors from Madrid show that this operation can be performed with respectable morbidity and mortality rates.