Background: Severe aortic stenosis (AS) in high-surgical-risk patients poses challenges in choosing between Transcatheter Aortic Valve Replacement (TAVR) and Surgical Aortic Valve Replacement (SAVR). TAVR has emerged as a less invasive option, but long-term outcomes and complication profiles compared with SAVR in high-risk cohorts remain an area of active evaluation.Objective: To compare short- and mid-term clinical outcomes of TAVR versus SAVR among high-risk patients undergoing aortic valve replacement at a tertiary care cardiac center.Methods: This retrospective observational study included 362 high-risk patients (Society of Thoracic Surgeons [STS] predicted risk of mortality ≥8%) with severe symptomatic AS who underwent TAVR (n = 188) or SAVR (n = 174) between January 2018 and December 2023. Primary outcomes included 30-day and 1-year all-cause mortality. Secondary outcomes included stroke, major bleeding, acute kidney injury (AKI), new pacemaker implantation, hospital length of stay, and functional status (NYHA class).Results: At 30 days, mortality was 5.3% in the TAVR group versus 7.5% in the SAVR group. At one year, mortality was 18.1% (TAVR) and 20.7% (SAVR). TAVR patients had lower rates of major bleeding (9.6% vs 21.3%) and shorter hospital stay (median 5 vs 9 days) but higher rates of new permanent pacemaker implantation (14.9% vs 6.3%). Stroke rates and AKI were comparable between groups. Improvements in NYHA class at one year were significant and similar in both groups.Conclusion: Among high-risk patients, TAVR offers comparable survival to SAVR at one year, with advantages of reduced bleeding and shorter hospitalization, balanced against a higher need for permanent pacemaker implantation. Individualized patient selection through heart team evaluation remains critical.