This study summarized the perioperative nursing experience of five patients with hypertrophic obstructive cardiomyopathy undergoing transapical beating-heart septal myectomy. In response a high preoperative risk of sudden cardiac death，the need for specialized bowel preparation，stringent postoperative volume management，elevated complication risks，and the necessity for tailored discharge planning，the following nursing measures were implemented. Those included risk-stratified preoperative interventions to ensure safe transition to surgery，optimized ultrasound-guided bowel preparation to achieve a clear surgical field，titrated volume management after surgery to maintain hemodynamic stability，a multi-dimensional early warning system for timely complication detection，and individualized discharge education to support recovery and improve quality of life. All five patients recovered successfully and were discharged. At one-month follow-up，five patients showed a significant decrease in left ventricular outflow tract pressure compared to preoperative levels，with overall good condition.