Purpose We evaluate clinical characteristics, management and prognosis of patients (Pts) with severe aortic stenosis (AS) hospitalized in a university hospital offering all therapeutic options: AVR, balloon aortic valvuloplasty (BAV) and transcutaneous heart valve implantation (TAVI) using the Edwards Sapien bioprosthesis. Methods We included 211 Pts with severe AS (EOA < 1 cm 2 and/or 0.6 cm 2/m 2), hospitalised between July, 2006 and July, 2007 in our center. Clinical, echocardiographic and angiographic characteristics, logistic EuroSCORE and STS score were evaluated. A prospective clinical and echocardiographic follow-up was performed at 1-year. Results 211 Pts (79 ± 9 years; 53% female) were included in the study. 58% of Pts were > 80 years old. 65% of Pts were highly symptomatic (NYHA 3-4). After multidisciplinary evaluation, 92 (43.6%) patients were referred to surgical AVR, 20 (9.5%) to TAVI, 62 (29.4%) to BAV and 37 (17.5%) were maintained on medical treatment alone. Pts treated by AVR were younger (74+/-9 vs 84+/-5, p<.0001) and had less frequent history of myocardial infarction (p=0.003) or coronary artery bypass grafts (p=0.0002), less renal failure (p<0.001), less severe lung disease (p=0.009), and less demetia (p=0.0002) than the 3 other groups. Operative risk was lower in the AVR group as assessed by Euroscore (8% vs 25%, p<.0001) and STS score (4.4 vs 13.0%, p<.0001). At one year, survival was excellent in the AVR group (99%) with no procedural death. At the opposite, 51% of Pts treated medically died. BAV improved symptoms (24% in NYHA IV vs 58% at baseline) and survival was 66% at 1-year. Survival rate in the TAVI group was 79% with marked symptoms improvement (70% of Pts in NYHA 1-2 vs 1% at baseline). Conclusions Patients with severe AS represent a very heterogeneous population. Surgical AVR remains the reference treatment with excellent results. However, TAVI is a promising alternative treatment in many Pts with heavy and multiple comorbidities.