Enhanced recovery programmes (ERP) reduce hospital stay and improve outcomes through a structured approach to perioperative care. We present our tailored protocol and results for first time AVR and CABG patients enrolled on ERP. Key elements are optimising co-morbidities, discharge planning, reduced starvation with carbohydrate loading. Intra-op focus is on minimally invasive techniques and analgesic planning. Post-op protocol aims to extubate early, reduce opiate analgesia using other agents, rapid mobilisation and return to normal diet and function.