A total of 200 patients with hypertrophic obstructive cardiomyopathy underwent transapical beating-heart septal myectomy under general anesthesia. Guided by transthoracic echocardiography, apical puncture, guidewire insertion, and resection of hypertrophic myocardial tissue were performed. All procedures were completed successfully. Operating room preparation included preoperative psychological preparation, gastrointestinal preparation, equipment preparation, operating room layout planning, and positioning preparation. Intraoperative nursing management involved thrombosis prevention techniques, strict aseptic practice, temperature management, and medication management.Systematic preoperative preparation was identified as the foundation for ensuring surgical efficiency and safety, while meticulous intraoperative coordination was considered essential for preventing complications and maintaining procedural safety.