Colchicine therapy in transcatheter aortic valve replacement: Modulating inflammation and outcomes

Transcatheter aortic valve replacement (TAVR) is frequently accompanied by inflammation-related complications, including conduction disturbances, atrial fibrillation, and subclinical leaflet thrombosis. Colchicine, with its anti-inflammatory and antithrombotic properties, has emerged as a potential adjunctive therapy to mitigate these post-procedural events. However, its specific role in the TAVR population remains insufficiently defined.

A narrative review approach was used. Searches of PubMed, Scopus, Web of Science, and Google Scholar were performed through September 2025 using terms related to "transcatheter aortic valve replacement," "TAVR," and "colchicine." Randomized trials, observational studies, mechanistic investigations, and guideline documents were screened. Findings were organized thematically to summarize mechanisms, therapeutic rationale, and clinical outcomes.

Only one randomized controlled trial and one observational study have directly evaluated colchicine after TAVR. Both demonstrated reductions in inflammatory biomarkers and signals toward improved conduction-related parameters, but clinical endpoints such as pacemaker implantation, sustained arrhythmias, and imaging-confirmed leaflet thrombosis remain insufficiently studied. Mechanistic and perioperative cardiac evidence from non-TAVR settings supports colchicine's potential by targeting inflammasome activity, microtubule regulation, and early thrombo-inflammatory remodeling.

Colchicine is a promising adjunctive strategy for attenuating inflammation-related complications after TAVR. Its multimodal actions align with the pathways implicated in conduction disturbances, atrial fibrillation, and leaflet thrombosis. However, current evidence is preliminary, with only two post-TAVR intervention studies available. Larger trials are needed to determine whether colchicine can translate mechanistic advantages into clinically meaningful improvements in post-TAVR outcomes.