There is limited data available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and follow-up periods of at least four years or longer. In this population-based cohort study, long-term mortality and morbidity were investigated in 18,882 patients in Austria undergoing surgical aortic valve replacement (SAVR) for severe aortic stenosis using a surgically implanted bioprosthesis. The primary outcome assessed was all-cause mortality in the overall and propensity score-matched populations, with secondary outcomes of reoperation and cardiovascular events. The study found that selection for TAVR was significantly associated with higher all-cause mortality compared to SAVR in patients 65 years and older with severe, symptomatic aortic stenosis over a follow-up period exceeding two years.