This paper summarized perioperative nursing experience for a patient undergoing heart transplantation following complex cardiac malformation surgery. Preoperative measures included implementing graded heart failure monitoring and rapid response protocols，and developing volume management strategies tailored to the patient’s anatomical features. Postoperative care focused on strengthening right heart preload and afterload monitoring to prevent right heart failure，dynamic infection risk assessment with precise removal of invasive catheters，targeted interventions for hyperlactatemia and hyperglycemia，and rehabilitation training aimed at social reintegration. The patient was transferred to the cardiac surgery ICU，with tracheal intubation removed after 13 hours. On the 4th postoperative day，the patient was successfully transferred to a general ward and was discharged after 27 days of hospitalization. During the 8-month post-discharge follow-up，the patient recovered well.