Aortic stenosis (AS) is a heart valve disease characterized by fixed obstruction of the left ventricular outflow. It can be managed by surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). However, real-world evidence for the outcomes of TAVI or SAVR is lacking in Taiwan. The objective of this study is to compare the clinical outcomes of TAVI and SAVR for the treatment of AS in Taiwan. National Health Insurance Research Database (NHIRD) is a nationally representative cohort that contains detailed registry and claims data from all 23 million residents of Taiwan. With this database, we conducted a retrospective cohort study comparing patients who underwent SAVR (bioprosthetic valves) or TAVI from 2017 to 2018. We compared the survival outcome and length of hospital and ICU stay between TAVR and SAVR in the matched cohort. We also performed multivariable Cox regression to identify the effect of treatment type on survival while controlling variables including age, gender, and comorbidities. We identified 320 patients who received TAVI and 1,988 patients received SAVR with bioprosthesis. Compared with SAVR patients, TAVI patients were older (82.4 vs. 67.2 y/o), and more likely to be female (57.5% vs. 36.5%). We matched 300 of TAVI patients with SAVR patients using age and gender. There was a significant difference in survival between TAVI and SAVR. The one-year mortality rate was 9.3% with TAVI and 23.3% with SAVR. Both the mean total length of stay (20.4 vs. 34.7 days) and mean ICU length of stay (6.5 vs. 16.4 days) for TAVI patients were shorter than SAVR patients. In the multivariate model, the adjusted rate of mortality with SAVR was 3.4 times higher than TAVI. In Taiwan, patients who underwent TAVI had better survival outcome and shorter length of stay compared with patients who underwent SAVR.