Annabi MS, Côté N, Dahou A, et al. - Researchers here used inverse probability of treatment weighting (IPTW) in order to compare aortic valve replacement (AVR) vs ConsRx (conservative management) and surgical AVR (SAVR) vs transcatheter AVR (TAVR) in a large prospective observational study of patients with low flow, low gradient (LFLG) aortic stenosis (AS). In the multicenter TOPAS (True or Pseudo Severe Aortic Stenosis) study, prospective recruitment of a total of 481 consecutive patients (75±10 years; 71% men) with LFLG AS (aortic valve area ≤ 0.6 cm2/m2 and mean gradient < 40 mm Hg) was performed, 72% with classic LFLG and 28% with paradoxical LFLG. Of these patients, 220 died during follow‐up (median [IQR] 36 [11–60] months). Relative to a strategy combining ConsRx or delayed AVR, early (< 3 months) AVR is linked with an important survival benefit in both the classic and paradoxical subsets of LFLG AS and in both true‐severe and pseudo‐severe AS. Findings here establish the superiority of early AVR to clinical surveillance in both classic and paradoxical low‐flow, low‐gradient aortic stenosis, whether with true‐severe or pseudo‐severe (ie, moderate) aortic stenosis. They suggest TAVR to be the best therapeutic option, especially using femoral access.