A randomized evaluation of the TriGuard HDH cerebral embolic protection device to Reduce the Impact of Cerebral Embolic LEsions after TransCatheter Aortic Valve ImplanTation: the REFLECT I trial. European heart journal Lansky, A. J., Makkar, R., Nazif, T., Messe, S., Forrest, J., Sharma, R., Schofer, J., Linke, A., Brown, D., Dhoble, A., Horwitz, P., Zang, M., DeMarco, F., Rajagopal, V., Dwyer, M. G., Zivadinov, R., Stella, P., Rovin, J., Parise, H., Kodali, S., Baumbach, A., Moses, J., REFLECT I Trial Investigators 2021


AIMS: The REFLECT I trial investigated the safety and effectiveness of the TriGuard HDH (TG) cerebral embolic deflection device in patients undergoing transcatheter aortic valve replacement (TAVR).METHODS AND RESULTS: This prospective, multicentre, single-blind, 2:1 randomized (TG vs. no TG) study aimed to enrol up to 375 patients, including up to 90 roll-in patients. The primary combined safety endpoint (VARC-2 defined early safety) at 30days was compared with a performance goal. The primary efficacy endpoint was a hierarchical composite of (i) all-cause mortality or any stroke at 30days, (ii) National Institutes of Health Stroke Scale (NIHSS) worsening at 2-5days or Montreal Cognitive Assessment worsening at 30days, and (iii) total volume of cerebral ischaemic lesions detected by diffusion-weighted magnetic resonance imaging at 2-5days. Cumulative scores were compared between treatment groups using the Finkelstein-Schoenfeld method. A total of 258 of the planned, 375 patients (68.8%) were enrolled (54 roll-in and 204 randomized). The primary safety outcome was met compared with the performance goal (21.8% vs. 35%, P<0.0001). The primary hierarchical efficacy endpoint was not met (mean efficacy score, higher is better: -5.3±99.8 TG vs. 11.8±96.4 control, P=0.31). Covert central nervous system injury was numerically lower with TG both in-hospital (46.1% vs. 60.3%, P=0.0698) and at 5days (61.7 vs. 76.2%, P=0.054) compared with controls.CONCLUSION: REFLECT I demonstrated that TG cerebral protection during TAVR was safe in comparison with historical TAVR data but did not meet the predefined effectiveness endpoint compared with unprotected TAVR controls.

View details for DOI 10.1093/eurheartj/ehab213

View details for PubMedID 34000004