Keystone Heart is focused on protecting the brain from emboli to reduce the risk of brain infarcts during TAVR, atrial fibrillation ablation and other structural heart procedures.

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Locations in Israel and Tampa, Fl

Israel | +972.4.615.8000 Tampa | (813) 530-8200

Want to learn more about Keystone Heart and our future plans of protecting the health of all those in need of surgery for heart conditions?

Protect Your Brain While Treating the Heart

CAUTION – The TriGUARD 3™ Cerebral Embolic Protection Device is CE marked. Approved for investigational use only in the US, not cleared by the US FDA. 


Keystone Heart aspires to be the world leader in cerebral embolic protection (CEP) during cardiovascular procedures.


To develop and manufacture novel devices that protect the brain from emboli to reduce the risk of brain infarcts during transcatheter aortic valve replacement (TAVR), atrial fibrillation ablation (AF ablation) and other structural heart procedures.

Preserving brain reserve during medical procedures is a key component to procedural success and patient care.

Want to see what we’re all about?

The TriGUARD 3 Cerebral Embolic Protection Device

  • Self-positioning, self-stabilizing
  • Polymeric mesh (pore size 115 x 145 µm)
  • 8 Fr OTW delivery
  • Designed to protect all three major arteries that supply blood to the brain
  • Eliminates need for third access site during TAVI
  • Removed upon completion of procedure

The TriGUARD 3™ Cerebral Embolic Protection Device is CE marked. Approved for investigational use only in the US, not cleared by the US FDA.

Clinical Trials moving TriGuard™ forward

DEFLECT I clinical data presented at PCR 2013 demonstrated a significant reduction of over 60% of new brain lesion volume during protected TAVR procedures using TriGuard™, compared with historical data on unprotected TAVR procedures.

DEFLECT II This study aims to evaluate the safety and performance of the new embolic deflection device TriGuard™HDH in patients undergoing TAVR.

DEFLECT III a multi-center, randomized clinical trial, conducted in 13 centers across Europe and Israel, is closed. Results have been published.

NUERO-TAVI ACC and EuroPCR Benefits of TriGuard™ Cerebral Protection Device During TAVR.

REFLECT a multi-center, randomized clinical trial of the TriGUARD™3 Embolic Deflection Device to reduce the impact of cerebral embolic lesions after TAVR. To learn more, visit the study information page at



Follow the progress of the TriGUARD 3™ Device in clinical trials, studies, and other developments.


Important safety information

Important safety information

OUS TriGUARD 3™ Cerebral Embolic Protection Device Important Safety Information


The TriGUARD 3 Cerebral Embolic Protection Device is designed to minimize the risk of cerebral damage by deflecting embolic debris away from the cerebral circulation during trans-catheter heart procedures.

Intended use
Reduce cerebral embolization during transcatheter heart procedures.


  • Hypercoagulable states that cannot be corrected by additional periprocedural heparin.
  • Renal failure with plasma creatinine > 4 mg/dl.
  • Hepatic failure.
  • Patients with allergy to nitinol or heparin
  • Patients with history of heparin-induced thrombocytopenia


  • Only physicians trained in the use of the device should use it.
  • The appropriate antiplatelet and anticoagulation therapy should be administered pre- and post-procedure to minimize the risk of embolism and thrombosis.
  • Porcine material as porcine allergens other than porcine heparin could be present
  • Failure to follow recommended device preparation and use of dry pad to wipe the filter may damage the hydrophilic coatings and potentially cause serious injuries to patients.
  • Introduce and advance devices slowly to prevent air embolism or trauma to the vasculature.
  • Do not attempt to move the handle without observing the resultant deflection-filter response.
  • Visualization of device position is essential for proper deployment. In procedures where visualization of the device via fluoroscopy is impeded by patient obesity or other reasons, do not attempt to deploy the device in the aortic arch.
  • Ensure visualization of the device when attempting to cross the aortic arch with any device. Uncontrolled interaction between the TriGUARD 3 Cerebral Embolic Protection Device and any other device may lead to undesirable movement of the deflection-filter, resulting in incomplete coverage of the ascending arteries.
  • To avoid damage to the device or injury to the patient, do not pull excessively on the device handle or
  • Rotation of the device handle may result in rotation or flipping of the device. Do not attempt to rotate or torque the device using any accessory tool or the device handle.
  • Single use device do not reuse or re-sterilize. Reusing the device may impose risk of inter-patient contamination, improper cleaning and compromised performance of the device.
  • In case of redeployment, first pull back the device into the sheath and then advance the sheath over the wire to the desired location. Once in the desired location, deploy per the instructions for use.
  • The safety and effectiveness of the device has not been evaluated in patient populations with the following conditions:
    • Variant angina pectoris, unstable angina or recent acute coronary syndrome including myocardial infarction (in the past three months).
    • Stroke, TIA – Transient Ischemic Attack (in the past 6 months).
    • Hypotension (systolic blood pressure of below 90mm Hg).
    • Active peptic disease or history of upper GI bleeding.
    • Spastic bronchitis, Chronic Obstructive Lung Disease, Asthma.
    • Complex ventricular arrhythmia or history thereof.
    • Major psychiatric disorder in the present or past.
    • Bleeding diathesis such as hemophilia, ITP, aplastic anemia, TTP etc.
    • Diabetes mellitus with peripheral vascular and/or neurologic changes.
    • Any proliferative disease with patient lifespan less than 6 months.
    • Pregnancy.
    • Pediatric use.

There are risks associated with any endovascular intervention and complications may develop. The following anticipated events have been identified as possible complications of trans-catheter procedures and these and others may be associated with the device:

  • Acute cardiovascular surgery (need for)
  • Acute coronary artery occlusion
  • Acute myocardial infarction
  • Acute neurological events such as: Stroke, transient ischemic attack (TIA), encephalopathy
  • Allergic reaction to contrast, antiplatelet therapy or device component materials
  • Angina pectoris
  • Anesthesia reactions
  • Aneurysm or pseudoaneurysm
  • Arteriovenous fistula
  • Ascending or descending aorta trauma
  • Atrial or ventricular arrhythmias or fibrillation, Heart Palpitations (sustained requiring therapy)
  • Bleeding complications such as hematoma and hemorrhage
  • Bleeding at access site
  • Blood loss requiring transfusion
  • Coronary artery or other vascular injury, dissection, or perforation which may need repair
  • Blue toe syndrome or blue discoloration of a toe
  • Bowel ischemia
  • Embolism (air, tissue, device, or thrombus)
  • Fever
  • Femoral nerve damage
  • Fluoroscopy related harm
  • Hemodynamic changes
  • Hypertension or hypotension (sustained requiring therapy)
  • Infection, including endocarditis and septicemia
  • Pain (at femoral puncture site, abdominal, back or other)
  • Percutaneous coronary intervention (need for)
  • Peripheral ischemia, peripheral nerve damage
  • Pulmonary edema
  • Pyrogenic reaction
  • Renal complications, injury, or failure
  • Unstable angina
  • Vascular complications which may require vessel repair
  • Vessel spasm (sustained, not responding to therapy)

In addition to the risks listed above, the potential risks specifically associated with the Keystone Heart TriGUARD 3 Cerebral Embolic Protection Device procedure includes, but may not be limited to, the following:

  • Dislodgement or migration of the TriGUARD 3 Cerebral Embolic Protection Device or its delivery system, due to passage of other instrumentation, e.g.: balloon, stent, catheter, wire.
  • Femoral bleeding at the access site.
  • Local trauma to the aortic wall due to device migration.