[Abstract]Objective:To explore the impact of refined intraoperative instrument management by operating room nurses on the efficiency and safety of HVR surgery.Methods:The study subjects included 110 patients with VHD who underwent HVR treatment at our hospital from June 2024 to May 2026, along with 22 instrument nurses who participated in the surgeries synchronously. Using the random number table method, the enrolled patients and nurses were divided into a control group (55 patients, 11 nurses) and an experimental group (55 patients, 11 nurses). Nurses in the conventional group implemented routine instrument management during surgery, while nurses in the experimental group implemented zoned and refined instrument management during surgery. The surgical efficiency, perioperative safety events of the two groups of patients, as well as the work efficiency and intraoperative instrument management of the surgeries participated by the nurses in the two groups were compared.Results:Under different instrument management modes, the aortic occlusion time, extracorporeal circulation time, intraoperative non-essential waiting time, and total surgical time of patients in the experimental group were all lower than the control group (t=8.817，5.730，20.609，9.632; P<0.05). The incidence of perioperative safety events in the experimental group was 9.09% (5/55) lower than that in the control group 25.45% (14/55) (x2=5.153; P<0.05). The instrument placement time, instrument delivery response time, number of surgical interruptions, instrument sorting time, and instrument handover time of nurses in the experimental group were lower than those in the control group (t=3.347，6.505，5.971，3.795，5.838; P<0.05). The error rate of nurses in the experimental group was lower than the control group (x2=5.238; P < 0.05).Conclusion:Refined intraoperative zone-specific instrument management by instrument nurses enhances surgical efficiency for HVR patients and reduces the risk of perioperative safety incidents, thereby positively impacting the quality of instrument care provided by nurses and preventing instrument-related adverse events.