Background
The incidence of aortic valve disease is constantly increasing. The definitive therapy is surgical or interventional, resulting in a clear improvement in the quality of life, with an extremely low operative risk. The most recent international guidelines place both procedures in class I in the age group between 65 and 80 years.

Materials and methods
A retrospective analysis of patients aged 65 to 80 years undergoing surgical isolated aortic valve replacement with sutureless bioprostheses (SU-AVR group), or trans-catheter (TAVR group) was performed at Maria Cecilia Hospital between January 2011 and December 2021. Using propensity score matching, intrahospital, 30-day, one-year and actuarial mortality and complications outcomes were analyzed in the two resulting groups.

Results
A total of 638 patients were included in the study, counting 338 (52.98%) in the SU-AVR group and 300 (47.02%) in the TAVR group. After propensity score matching, two groups of patients (124 per group) were obtained without statistically significant differences in preoperative comorbidities. Mortality at 30 days was comparable in the 2 groups. The TAVR group showed a significantly higher incidence of definitive pacemaker implantation and major vascular damage, while the SU-AVR group showed a higher incidence of atrial fibrillation, transfusions and renal failure. One-year all-cause mortality was significantly higher for the TAVR group, and the gap continues to increase with time.

Conclusions
Transcatheter aortic valve replacement (TAVR) shows very good results in the short term in patients between 65 and 80 years of age. At medium-term follow-up, however, preliminary results show a better outcome of patients undergoing surgical valve replacement, both in terms of all-cause mortality and major cardiovascular and cerebrovascular events.