Background: Transcatheter aortic valve replacement (TAVR) has become a widespread alternative to surgical aortic valve replacement (SAVR) in high- and intermediate-risk patients with aortic valve stenosis. However, there is ongoing debate regarding the long-term outcomes of TAVR compared to SAVR, especially as TAVR use rises in younger patients. Aim : To evaluate and compare the five-year all-cause mortality between TAVR and SAVR procedures in a real-world Belgian cohort. Methods: Patients undergoing bioprosthetic aortic valve replacement at Cliniques Universitaires Saint-Luc, Brussels, from January 2010 to December 2020 were included. Exclusions were made for those who underwent transapical/transaortic TAVR or SAVR involving non-CABG associated surgery. Multivariate Cox regression and 1:1 propensity-score matching were used to address baseline characteristic imbalances. Results: The population included 1183 SAVR and 525 TAVR patients. Notably, TAVR patients were significantly older (84.8±6.4 vs 74.1±8.0 years, p<0.001) and presented a higher EuroSCORE II (4.9 [2.9-7.2] vs 2.0 [1.3-3.4] %, p<0.001). Propensity-score matching produced a balanced cohort of 440 patients, with a mean age of 81.5±6.3 years and a median EuroSCORE II of 3.5 [2.2-5.5] %. The TAVR group had a higher 5-year all-cause mortality than SAVR patients (66% vs 20%, HR 4.6, 95%CI 3.7-5.5, p<0.001), even after adjusting for the baseline characteristic imbalances with Cox regression (47% vs 22%, HR 2.4, 95%CI 1.8-3.1, p<0.001) or propensity-score matching (63% vs 35%, HR 2.1, 95%CI 1.5-3.0, p<0.001). Conclusion: In a real-world Belgian cohort, TAVR was independently associated with a notably higher five-year all-cause mortality compared to SAVR, aligning with findings from large international studies. These pivotal insights into the long-term outcomes of TAVR underscore the need for cautious consideration when expanding its indications, particularly among younger patient populations.