Among elderly patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR), a high prevalence (13–16 %) of coexisting transthyretin cardiac amyloidosis (CA) has been reported [[1], [2], [3], [4], [5], [6]], which significantly exceeds the estimated prevalence of CA in the general population [7,8]. Individually, both AS and CA are associated with symptoms of heart failure, cardiac remodeling and dysfunction and premature mortality [[9], [10], [11], [12]]. Several non-randomized studies have demonstrated similar mortality in AS-CA compared to lone AS after transcatheter aortic valve replacement (TAVR), at a median follow-up of 1.6–2.0 years [1,4,6]. Conversely, medical therapy was associated with a higher mortality compared to TAVR in patients with AS-CA, concluding that TAVR should not be withheld because of the coexistence of CA [1]. With the advent of novel CA-specific therapies [13,14], there is now a pertinent question of whether the residual amyloid component following AVR should be treated in patients with AS-CA. In order to answer this, the clinical significance and prognostic implications of this persistent amyloid component need to be addressed. However, the longer term outcome data on all-cause, and cardiovascular (CV) mortality as well as heart failure hospitalization with AS-CA remains unknown. The aim of this study was to compare, at longer term follow-up (5 years), both mortality and heart failure hospitalizations in patients with AS-CA to those with lone AS using a multicenter, prospective, observational cohort.