Regarding the risk factors in open heart surgery, there are very many and it all depends on what ailment the open heart surgery is being performed for. 1) One of the most important risk factor for open heart surgery is the stage at which the patient presents for open heart surgery. If a patient comes too late in the disease process then there are changes and damage to the lungs and to the heart and that increases the risk of surgery. Therefore, one must always take early medical advice and go in for treatment at an early stage rather than late. When the pressure of the lungs goes up (Pulmonary Hypertension) and muscles of the heart become weak, the risks in any surgical intervention will increase proportionately.2) Needless to say elderly age group, obesity, presence of diabetes, hypertension or any other associated disease process of the body such as tuberculosis, advanced malignancy or kidney damage is a risk factor for surgery.3) Smoking is an important risk factor because it damages the lungs and reduces the effort tolerance of an individual as well as the oxygen exchange across the lung gets reduced and therefore is in itself an independent risk factor for any surgery.4) Female gender is also a risk factor with the risk of surgery almost twice that in the male gender.5) The nature of the disease also dictates the risk involved as most congenital heart diseases would have a higher risk for surgery followed by valves and probably the least is for coronary artery bypass surgery.