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Introduction Aortic stenosis (AS) is the most common valvular heart disease, affecting 12,4% of elderly patients over 75 years old. For those needing SAVR but who are ineligible to undergo such a demanding procedure, TAVI is a less invasive approach. Methods This study used data from patients undergoing SU-AVR at U.Z. Gasthuisberg, Leuven and data reported in the literature concerning TAVI to compare short- and long-term outcomes in both groups for moderate risk patients. The patients from the SU-AVR were a subgroup from a multi-center study, the Cavalier trial. A literature search was performed to attain data from patients, with a EUROSCORE II or STS risk score similar to the SU-AVR group, undergoing TAVI. Results The rate of permanent pacemaker implantation at hospital discharge after SU-AVR was 7.9%. At 1,2 and 3 years, the Kaplan-Meier survival rate was 90.2, 85.1 and 78.1, respectively. Median in-hospital length of stay after SU-AVR was 13.9±9.1. Occurrence of any paravalvular or mild to moderate central aortic valve leakage was 8.6% and 5.3%, respectively. Median transaortic peak gradient and mean gradient after SU-AVR were 27.8±10.3 and 15.3±6.1. The median effective orifice area at discharge was 1.53±0.5. Discussion We found that SU-AVR had a better survival, less need for pacemaker implantation and lower rates of paravalvular leakage, whereas TAVI had lower aortic-valve gradients, larger aortic valve areas and a shorter hospital stay. The overall better survival of patients treated with SU-AVR can partially be contributed to their slightly younger age. It is not known if the better hemodynamics in the TAVI group have a clinical effect, as aortic-valve hemodynamics are substantially improved in both the TAVI and SU-AVR group. Conclusion TAVI and SU-AVR are both safe alternatives to SAVR with proven efficacies. TAVI remains most beneficial in high risk patients while SU-AVR has found its place filling the gap between SAVR and TAVI. Studying Perceval valve (SU-AVR) data from U.Z. Gasthuisberg corroborates many findings described in the literature such as the higher incidence of paravalvular leakage and favorable valvular gradients in the TAVI group. However, lower mortality and need for pacemaker implantation in our Perceval cohort offer a slight discrepancy as these were not shown to be significantly different in previous publications. Future studies should focus on randomized trials and long term follow-up, as life expectancies for TAVI and SU-AVR candidates continue to increase.