Objective To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) protocol in elderly patients receiving cardiac valve surgery under cardiopulmonary bypass (CPB). Methods Elderly inpatients who were scheduled for valve plasty or replacement under CPB due to cardiac valve diseases were prospectively enrolled. According to the random number table method, they were divided into an ERAS group (n=22) and a control group (n=28). Patients in the ERAS group received ERAS protocol for perioperative management, while those in the control group received routine perioperative treatment. Both groups were compared for the length of hospitalization stay, the length of intensive care unit (ICU) stay, the indwelling time of tracheal catheters after surgery, the dosage of sufentanil, the recovery time, the consumption of red blood cell suspension after surgery, post‑operative hematoglobin (Hb), the first defecation time after surgery, the time of postoperative use of vasoactive agents, the extubation time of drainage tubes after surgery, the Visual Analogue Scale (VAS) scores after surgery, hospitalization expense and postoperative adverse reactions. Results Compared with the control group, the ERAS group showed decreases in the length of hospitalization stay, the length of ICU stay, the indwelling time of tracheal catheters after surgery, the recovery time, the first defecation time after surgery, the time of postoperative use of vasoactive agents, and the extubation time of drainage tubes after surgery, where statistical differences were found as to the length of ICU stay, the indwelling time of tracheal catheters after surgery, the recovery time, the first defecation time after surgery, and the extubation time of drainage tubes after surgery between the two groups (P<0.05). Patients in the ERAS group required less doses of sufentanil than those in the control group (P<0.05). Patients in the ERAS group presented less postoperative adverse reactions than those in the control (P<0.05). There was no statistical difference as to the consumption of red blood cell suspension after surgery, post‑operative Hb, the VAS scores after surgery, and hospitalization expense between the two groups (P>0.05). Conclusions ERAS protocol is safe and effective for elderly patients receiving cardiac valve surgery under CPB.