Objective: To explore the extent of myocardial injury and the impact on myocardial perfusion in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Methods: A retrospective analysis was conducted on 77 patients with severe aortic valve stenosis and no significant coronary artery stenosis who underwent TAVR and SAVR surgeries and completed a 1-month follow-up. Myocardial injury indicators were observed: creatine kinase MB (CK-MB) and troponin I (cTnI) before surgery and on postoperative day 1, 3, 7, and 1 month. Myocardial perfusion indicators were also observed: total myocardial perfusion score, total number of myocardial ischemic segments, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and abnormal perfusion area under the 17-segment myocardial perfusion distribution using rest dynamic single-photon emission computed tomography (D-SPECT) + regadenoson stress D-SPECT before and 1 month after surgery. The above indicators were used to evaluate the impact of TAVR and SAVR on myocardial injury and myocardial perfusion. Results: Myocardial injury indicators: Both cTnI and CK-MB in the two groups of patients showed significant changes over time, reaching their peak values on postoperative day 1, and the TAVR group was lower than the SAVR group (P<0.05). Myocardial perfusion indicators: 1 month post-operation, both groups showed significant improvement in the number of myocardial ischemic segments, total myocardial perfusion score, and abnormal perfusion area compared to pre-operative levels (P<0.05). The TAVR group demonstrated better results in terms of total myocardial perfusion score under rest and stress conditions, as well as abnormal perfusion area, compared to the SAVR group (P<0.05). Conclusion: Both TAVR and SAVR can improve myocardial perfusion levels, TAVR causes less myocardial damage during surgery and offers superior myocardial perfusion improvement 1 month post-surgery compared to SAVR.