Objective: To summarize the perioperative nursing experience of five children with orthotopic heart transplantation. Methods: Five children underwent heart transplantation were collected from August 2020 to July 2022. The recipients were(100.60±55.49) months old, and the youngest one was 1 year and eleven months and weighed(30.60±14.43) kg. One case was diagnosed with dilated cardiomyopathy before operation, accompanied by pulmonary hypertension, mitral and tricuspid regurgitation and cardiac function grade Ⅳ. One case was diagnosed with hypertrophic cardiomyopathy. One case was complex congenital heart disease failed in aortic valve operation for three times, assisted by extracorporeal membrane oxygenation(ECMO). Two cases were diagnosed with noncompaction of myocardium. Five children were operated under general anesthesia with hypothermic extracorporeal circulation for double vena cava allograft orthotopic heart transplantation. The duration of cardiopulmonary bypass was(208.80±30.91) min, the duration of aortic occlusion was(108.80±12.38) min, and the duration of donor heart cold ischemia was(431.00±84.60) min. Postoperative routine organ function support, anti-rejection treatment and infection prevention were routinely provided. Results: All five children survived during the perioperative period, and were followed up from 5 months to 22 months with good cardiac function, no obvious abnormality in liver and kidney function, normal blood sugar and blood lipid range, and no complications related to immunosuppressants were found. Conclusion: Heart transplantation is a complex operation, long extracorporeal circulation time, and many postoperative complications. To ensure the safety of children with heart transplantation and improve the success rate of surgery, the nursing staff should grasp the key points and difficulties of heart transplant nursing, monitor closely, find problems in time, and intervene as early as possible.