Background: Decreasing right ventricular (RV) and left ventricular (LV) function after surgical or transcatheter aortic valve replacement (SAVR or TAVR, respectively) is an important risk factor for morbidity and mortality. Although transapical (TA)-TAVR is an independent risk factor for post-procedural mortality, limited knowledge is available regarding long-term changes in RV and LV function. The study aimed to evaluate LV and RV performance following four different AVR procedures, including TA-, transfemoral (TF)-TAVR, and SAVR with and without coronary artery bypass grafting (±CABG). Methods: Patients with severe AS were consecutively included and assigned to TA-TAVR, TF-TAVR, or SAVR ±CABG groups. A total of 130 patients underwent preoperative conventional and strain-rate-imaging echocardiography, with similar controls in the period between 6 and 12 months after the procedure. Results: After AVR, NYHA classes III and IV were reduced from 105 (81%) to 6 (5%) patients. While most of the systolic and diastolic functional parameters indicated improved LV function in the TF-TAVR and both SAVR groups, LV function did not significantly change after TA-TAVR. The right ventricular functional parameters were unchanged or even improved equally after TA-TAVR and TF-TAVR, while they were significantly reduced after SAVR. The Cardiac Index (CI) improved significantly after TF-TAVR from 2.3±0.7 to 2.6±0.7, while staying unchanged after TA-TAVR and SAVR±CABG. Conclusion: This study demonstrated significant changes in LV and RV systolic and diastolic function with functional improvement or deterioration depending on the type of aortic valve replacement. The most significant improvement in CI was observed after TF-TAVR, which is the least invasive procedure.