Objective To investigate the efficacy and safety of transcatheter aortic valve replacement (TAVR) in the treatment of very old patients with aortic stenosis. Methods Clinical data of 142 aged patients with aortic stenosis undergoing TAVR in our hospital from January 2019 to December 2020 were collected and retrospectively analyzed. Among them, 22 patients (≥80 years old) were assigned into the very old group, and the other 120 ones (65-80 years old) into the elderly group. The perioperative outcomes were compared between the 2 groups. SPSS statistics 20.0 was used for statistical analysis. Inter-group comparison was performed using Chi-square test, student′s t test or Fisher exact test depending on different date types. Results During the perioperative period, there were no statistical differences in the ratios of being converted to surgery (0.0％ vs 1.7%), intraoperative extracorporeal circulation (0.0％ vs 0.8%), intraoperative left ventricular rupture (0.0％ vs 0.8%), post-operative ECMO assisted circulation (0.0％ vs 1.7%), incidence rate of postoperative peripheral vascular complications (0.0％ vs 3.3%), postoperative pacemaker implantation (4.5％ vs 8.3%), postoperative disabled stroke (0.0％ vs 0.8%), and perioperative mortality rate (0.0％ vs 0.8%) between the very old group and the elderly group (P>0.05). There were 6 patients (4.2%) undergoing TAVR with non-femoral artery approach, including 1 patient (0.7%) with left subclavian artery approach, 1 patient (0.7%) with ascending aorta approach, and 3 patients (2.5%) with transcarotid approach in the elderly group; and 1 case (4.5%) in the very old group via carotid artery approach, and no statistical difference was seen between the 2 groups (P>0.05). Conclusion TAVR is an effective and safe treatment for elderly patients with aortic stenosis.