Fast-track surgery has been widely implemented and allows such immediate extubation as in the operating room(OR). We retrospectively investigated the effect of routine ultra-fast-track(UFT) surgery extubating in the OR in patients undergoing cardiovascular operations. Among 333 consecutive patients, 224 (67.3%)were extubated in the OR. Five patients were re-intubated, but none were because of heart or respiratory failure. Independent predictors for failure of OR extubation were preoperative renal failure, pre-existent cerebrovascular disease, emergency surgery, and prolonged operation and/or cardiopulmonary bypass times. In patients extubated in the OR, postoperative pneumonia and delirium were less frequent, oral intake was facilitated, and lengths of stay in the intensive care unit as well as hospital were shortened. UFT in cardiovascular surgery can be safely and effectively performed in a majority of patients.