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Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established treatment options. Neurological complications such as subclinical cerebral ischemia, delirium, and postoperative cognitive decline can occur during either treatment; however, precise data on neurological impairment remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to compare neurological outcomes of patients undergoing TAVI or SAVR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>COSTA (Cognitive Outcome after Surgical and Transcatheter Aortic valve replacement) is a single-center sub-study of the randomized DEDICATE trial (clinicaltrials.gov ID: NCT04535076). Neurocognitive tests (memory, attention, language, executive functions), questionnaires on neuropsychology (cognitive failures questionnaire [CFQ], hospital anxiety, and depression scale [HADS]), and health-related quality of life (SF-36) were used before intervention and 3\u00a0months thereafter. Cranial magnetic resonance imaging (MRI) was carried out post-intervention. In addition, there was a systematic assessment of delirium during the hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study cohort (mean age 71.8\u00a0years, 32% female) consisted of SAVR (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913) and TAVI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918) patients. In the SAVR group, subsyndromal delirium was more common (54 vs. 11%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017; OR\u2009=\u20098.58), visual recognition ability was worse (mean difference (MD)\u2009=\u2009\u2009\u2212\u20090.6 vs.\u2009+\u20090.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.14), and emotional impairment was numerically more declined (MD\u2009=\u2009\u2009\u2212\u200936.8 vs.\u2009\u2212\u20094.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.058,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.12) when compared to the TAVI group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this small, exploratory sample, SAVR showed a trend toward less favorable neuropsychological outcomes compared with TAVI in patients with low-to-intermediate surgical risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov Identifier: NCT04535076. 27 August 2020 (retrospectively registered).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  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