This is a review of papers presented at the international symposium on 'Quality of Life after Open Heart Surgery' comprising the experience in more than 20,000 patients. Early identification and operation of premorbid personalities, psychological counselling before and after the operation, explanation of true risks, an educational programme in redefinition of family roles, stressing the importance of returning to normal activity in education, employment and society, financial support through health insurance to cover the high cost of open heart surgery, and formulating socioeconomic policies which encourage returning to work yield improvement in all patient groups. Specific to valve replacement is patient participation in deciding the kind of prosthesis and improvement of anticoagulation strategies. Coronary bypass patients benefit broadly through a comprehensive rehabilitation programme. For congenital heart disease, emphasis was laid on the need to educate parents about the disease, the importance of open discussion between parents, the patient and the paediatric cardiologist, and the function of a parents' self-help group. For heart transplantation the endeavour must be to increase donor availability and to develop better immunosuppression schedules. Lastly, general awareness of patients' abilities will facilitate their social integration and improve their quality of life.