Introduction: In patients undergoing major surgery like cardiovascular surgery, the need for protein and energy increase due to surgical stress. Moreover geriatric patients with malnutrition undergoing these major surgeries constitute high risk groups. In this case report we present the nutrition protocol in intensive care unit in order to improve the healing process of a 68- year old woman with significant tricuspid and mitrale valve failure, and moderate aortic valve failure, who was scheduled for valve replacement operation. Case: Patient was assessed 7 days before the operation and a nutrition plan for 1219 kcal per day due to Harris Benedict formula was set. The patient could take less than 1/3 of these calories due to his diet. In addition his diet, ensure plus 250cc (375 kcal) 3 times daily between main meals was given in order to provide for his required kcal need. Parenteral nutrition with 1200 kcal was started 2 days after the operation, and the patient was extubated on 5th postoperative day. Due to the inability to obtain 1341 kcal which was necessary for enteral feeding, perative 3x325 kcal intensive care nutrition product was added to the diet. The patient was transferred to ward on postoperative 12th day. During the follow-up, vital signs were stable and the patient was discharged with good recovery on postoperative 14th day.Preoperative nutrition support may contribute to the stabilization of intraoperative and postoperative vital signs in patients with high risk.