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Objective To evaluate the improvement in the quality of early postoperative recovery in patients undergoing cardiac valve surgery with remimazolam-based fast - track anesthesia, and to provide a reference for the clinical optimization of fast - track anesthesia and Enhanced Recovery After Surgery (ERAS) protocols. Methods We selected elective surgery patients undergoing median sternotomy for cardiac valve replacement and/or repair under general anesthesia with extracorporeal circulation. Based on routine anesthesia assessment and fast-track anesthesia suitability assessment, a total of 228 patients were strictly enrolled according to the inclusion and exclusion criteria and randomly divided into two groups: the Remimazolam group (n = 114) and the Propofol group (n = 114) . Patients in the Remimazolam group were induced and maintained with remimazolam for anesthesia, while patients in the control group were administered propofol. We recorded the general information and surgical data of the patients, the QoR-15 scores before surgery (1 day preoperatively), 1 day postoperatively, 3 days postoperatively, and 1 day before discharge, as well as hemodynamic parameters at key time points after admission, the incidence of hypotension and bradycardia after anesthesia, the duration of surgery, anesthesia duration, postoperative mechanical ventilation time, ICU stay, postoperative hospital stay, and the incidence of perioperative cardiovascular adverse events and the incidence of early postoperative complications. Results There was no statistically significant difference in general data and QoR-15 scores between the two groups 1 day before surgery (P > 0.05) . The QoR-15 score of the Remimazolam group 1 day before discharge was higher than that of the Propofol group, with a statistically significant difference (P < 0.05), but the difference was less than the minimum clinically important difference, which is less than 8, indicating no significant clinical benefit. One minute after intubation and one minute after skin incision, the heart rate in the Propofol group slowed down and the Mean Arterial Pressure (MAP) significantly decreased, with a statistically significant difference between the groups (P < 0.05), there was no statistically significant difference in heart rate and MAP at other times. The incidence of intraoperative hypotension and bradycardia was lower in the Remimazolam group than in the Propofol group, with a statistically significant difference (P < 0.05) . The duration of postoperative mechanical ventilation, ICU stay, postoperative hospital stay, and the rate of re-intubation were all shorter in the Remimazolam group than in the Propofol group, and the success rate of fast-track anesthesia was higher in the Remimazolam group, with a statistically significant difference (P < 0.05) . There was no statistically significant difference in the incidence of perioperative complications between the two groups. Conclusions Compared with the commonly used intravenous anesthetic propofol, the remimazolam-based fast-track anesthesia regimen did not significantly improve the postoperative recovery quality scores in patients undergoing cardiac valve surgery. However, remimazolam had advantages in maintaining hemodynamic stability, increasing the success rate of fast-track anesthesia, shortening postoperative ICU stay and hospital stay, and is a viable intravenous anesthetic option for cardiac surgery patients. [ABSTRACT FROM AUTHOR]