Objective To investigate the effect of previous open heart operations (POHO) on the outcome of heart transplantation (HTX).Methods Between November 1984 and May 1996, HTX was performed on 151 patients at Hartford Hospital. Among them, 61 patients had previous open heart operations (POHO) (group A), and 90 did not (group B). The average follow-up period was 1615±1185 days for group A and 1330±1125 days for group B. The recipient age was 55±10 years for group A and 48±12 years for group B (P<0.01). There were 17 patients (26%) in group A and 14 (50%) in group B who were over 60 years of age. There was more coronary artery disease (74% versus 37%, P<0.001) as etiology, and more diabetics in group A (P<0.02). Results The time for cardiopulmonary bypass (133±20 min versus 106±18 min, P<0.01) and aortic clamp time (73±16 min versus 61±13 min, P<0.01) were longer in group A. The operative mortality (within 30 days) was 0 and 2.2%, and the cumulative deaths were 16 (26%) and 43 (48%) respectively for group A and group B (P<0.01). The causes of death were (group A vs group B): infection (31% vs 26%), rejection (13% vs 28%, P<0.05), malignancy (25% vs 16%), cardiac event (6% vs 14%) and others (25% vs 16%). In patients over 60, there were 4 deaths (24%) in group A and 7 (50%) in group B. The difference was not significant. No patients died of rejection in this subgroup. The actuarial survival rates in group A versus group B were: 1 year, 93% versus 83%; 2 years, 85% versus 74%; 3 years, 81% versus 71%; 5 years, 76% versus 58%; and 10 years, 57 % versus 24% (P<0.01).Conclusion The survival rate in patients who had POHO is much higher than that in patients who had HTX as their primary operation.