Eighty patients (40 TAVR and 40 SAVR) were included in the study cohort (see Fig. 2 for details of patient inclusion); the median age of the included patients was 76.5 years (IQR 70–83), 65% were men, 20% had bicuspid aortic valves. Baseline and intra-procedural characteristics of patients in the two groups are summarized in Table 1.

In the TAVR group, the transfemoral approach was used in 39/40 patients (97.5%) while in one patient the left subclavian approach was used. The TAVR valves implanted were Edward Sapien 3 (35/40, 87.5%) and Medtronic Core valve (5/40, 12.5%). In the SAVR group, all surgeries were performed open sternotomy with cardiopulmonary bypass and implanted 82.5% Edwards Lifesciences (PERIMOUNT Magna™ and INSPIRIS™ RESILIA valves), and 17.5% Medtronic (Mosaic™, Avalus Bovine Aortic Surgical Valves), based on surgeon preference.

The change in GCS (Delta GCS, pre vs. post-procedure GCS) was significant in the TAVR (median 10.7 [IQR 4.5, 14.6] vs. 17.0 [IQR 6.1, 20.9], p = 0.009) but not in in the SAVR group (4.4 [IQR 3.3, 5.3] vs. 4.7 [IQR 3.9, 5.6], p = 0.3) (Table 2); the delta GCS was significantly higher in the TAVR group compared to the SAVR group: 2.8% [IQR 1.4, 6] vs. 0.15% [IQR − 0.6, 1.5], p < 0.001 (Table 4). The percentage delta GCS was also significantly greater in the TAVR versus SAVR group (28.8% [IQR 14.6, 64.6] vs. 4.4% [IQR − 10.6, 56], p = 0.006). (Table 3).

The pulse-pressure corrected GCS was significantly higher post-procedure in the TAVR (13.6% [IQR 8.6, 23.5] vs. 26.8% [IQR 10.6, 32], p = 0.012) but not in the SAVR group (6.8% [IQR 5.5, 9.2] vs. 7.6% [IQR 6.1, 10.8], p = 0.2). The pulse-pressure corrected delta GCS was also significantly greater in the TAVR compared to the SAVR group (6.1% [IQR 1.6, 12.3] vs. 1.3% [IQR − 1.5, 3.2], p < 0.001). (Table 3).

In the fully adjusted ANCOVA model, the delta GCS and the percentage delta GCS were both significantly greater in the TAVR compared to the SAVR group (0.2% ± 0.8 vs. 4.2% ± 0.8, p < 0.001 and − 1.8% ± 13.3 vs. 62.0% ± 13.3, p < 0.010 respectively, Table 3, Fig. 3). The delta GCS/PP and percentage delta GCS/PP were also significantly greater in the TAVR versus SAVR groups (0.5% ± 2.1 vs. 9.2% ± 2.1), p < 0.024, and 9.5% ± 18.4) vs. 81.6% ± 18.4, p < 0.035).

Effect plots showing A delta GCS (%) among TAVR versus SAVR after adjustment for key baseline and hemodynamic variables using ANCOVA and B percent change GCS (%) among AVR versus TAVR after adjustment for key baseline and hemodynamic variables using ANCOVA

In the sensitivity analysis excluding BAV patients, both delta GCS and percentage delta GCS remained significantly greater after TAVR versus SAVR before and after ANCOVA with adjustment for key variable (Additional file 1: Tables S1 and S2). In the sensitivity analysis adjusted by imaging modality, the results remained solid after accounting for imaging modality in the multivariable ANCOVA model (TEE vs. TTE) (Additional file 1: Table S3).

Post-procedure TTP and distensibility were significantly higher in the TAVR group (300 ms [IQR 280, 385] vs. 195 ms [IQR 166.8, 250], and 4.9 (10−3 mmHg) [IQR 1.4, 7.6] vs. 1.4 (10−3 mmHg) [IQR 1.1, 1.7], p < 0.001 for both—Table 4).

There were no significant differences between the pre and post-procedure delta GCS/PP, delta EDA, delta ESA, and delta FAC, delta area, or aortic ESA and conventional imaging variables between the TAVR and SAVR groups (Tables 3, 4).

Hemodynamics and measures of left ventricular function in the two groups at the different timepoints are presented in Table 5.