Background The debate about the optimal approach for aortic valve replacement continues. We compared the hospital and long-term outcomes (survival, aortic valve reintervention, heart failure readmissions, and stroke) between transcatheter vs. surgical (TAVR vs. SAVR) aortic valve replacement. The study included 789 patients; 293 had isolated SAVR, and 496 had isolated TAVR. Patients with concomitant procedures were excluded. Propensity score matching identified 53 matched pairs. Results Patients who had TAVR were significantly older ( P ˂ 0.001) and had significantly higher EuroSCORE II ( P ˂ 0.001), NYHA class ( P ˂ 0.001), and more prevalence of diabetes mellitus ( P ˂ 0.001), hypertension ( P ˂ 0.001), chronic lung disease ( P = 0.001), recent myocardial infarction ( P = 0.002), and heart failure ( P ˂ 0.001), stroke ( P = 0.02), atrial fibrillation ( P = 0.004), and previous percutaneous coronary interventions ( P ˂ 0.001) than SAVR patients. In the matched cohort, atrial fibrillation occurred more frequently after SAVR ( P = 0.01), and hospital stay was significantly longer in SAVR patients ( P ˂ 0.001). There were no differences in hospital mortality between groups ( P ˃ 0.99). Survival at 1, 3, and 5 years was 97%, 95%, and 94% for SAVR and 91%, 79%, and 58% for TAVR patients. Survival was lower in TAVR patients before matching ( P ˂ 0.001) and after matching ( P = 0.045). Freedom from the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission at 1, 3, and 5 years was 98.9%, 96%, and 94% for SAVR and 94%, 86%, and 75% for TAVR. The composite endpoint was significantly higher in the TAVR group than in SVR before matching ( P ˂ 0.001), while there was no difference after matching ( P = 0.07). There was no significant difference in the change in ejection fraction between groups ( β : −0.88 (95% CI : −2.20–0.43), P = 0.19), and the reduction of the aortic valve peak gradient was significantly higher with TAVR ( β : −7.80 (95% CI : −10.70 to −4.91); P ˂ 0.001). Conclusions TAVR could reduce postoperative atrial fibrillation and hospital stay. SAVR could have long-term survival benefits over TAVR with comparable long-term stroke, heart failure readmission, and aortic valve reinterventions between SAVR and TAVR.