In this article, the authors report six-year outcomes from the Evolut Low Risk trial, which randomized 1,414 low-risk patients with severe aortic stenosis to transcatheter aortic valve replacement (TAVR) (n=730) or surgery (n=684). At six years, the composite of all-cause mortality or disabling stroke was similar: 23.3 percent in the TAVR group vs 20.4 percent in the surgery group (P=0.43). All-cause mortality was 23.3 percent vs 20.2 percent (P=0.24). However, reintervention was higher after TAVR: 5.5 percent vs 3.3 percent at six years (P=0.07), increasing to 9.8 percent vs 6.0 percent at seven years (sHR 1.68, P=0.02). This excess was driven by regurgitation-related reintervention (5.6 percent vs 1.6 percent, P<0.001), whereas stenosis rates were similar (3.6 percent vs 3.5 percent). The authors suggest that the excess regurgitation may relate partly to off-guidance post-dilation and emphasize the importance of continued long-term durability surveillance.