A subpopulation of older patients with symptomatic aortic stenosis are referred for transcatheter aortic valve replacement (TAVR) but do not undergo any procedure. We sought to categorize the clinical and geriatric profiles of patients not undergoing TAVR and determine their restricted median survival time (RMST). Older adults assessed between 2014-2018 at the McGill TAVR clinic were prospectively enrolled. In addition to patients who underwent TAVR (Group A), those who did not undergo a procedure within one year of their clinic evaluation were categorized according to the following reasons: patient (Group B) or physician (Group C) decision not to proceed, waiting for the procedure or for a decision to be made (Group D), undergoing valvuloplasty as a potential intermediate to TAVR (Group E). For patients in each group, the RMST and Cox proportional hazard ratio for mortality were computed over 1 year adjusting for the Society of Thoracic Surgeons risk and Essential Frailty Toolset score. Patient-level predictors for not undergoing TAVR were examined using multivariable logistic regression. The cohort consisted of 377 patients with a mean age of 82.3 years, of which 233 underwent TAVR and 144 did not. Relative to group A (N=233), the difference in the adjusted RMST was -29 days (95% CI -67, 8) in group B (N=24), -36 days (95% CI -63, -10) in group C (N=68), -141 days (95% CI -203, -78) in group D (N=29), and 5 days (95% CI -29, 38) in group E (N=23). This corresponded to an adjusted hazard ratio for mortality of 3.64 in group B (95% CI 1.50, 8.84), 3.75 in group C (95% CI 1.93, 7.23), 14.00 in group D (95% CI 6.70, 29.25), and 1.33 in group E (95% CI 0.45, 3.93). Kaplan-Meier survival curves were superimposed for TAVR and valvuloplasty patients until 8 months, after which valvuloplasty patients accrued more fatalities. Patient-level predictors for not undergoing TAVR were: age ≥90 years, high Essential Frailty Toolset score, disability for activities of daily living, severe lung disease, severe kidney disease, and reduced left ventricular ejection fraction. Older patients who are referred for TAVR but do not undergo a procedure have reduced survival time, especially when waiting for the TAVR procedure or decision. Those undergoing a valvuloplasty appear to be protected for approximately 8 months. Efforts should be made to minimize TAVR wait times or consider balloon valvuloplasty when a TAVR decision is deferred.