Seventy of 142 survivors of open-heart surgery returned for follow-up interviews one year after operation. Over 90% of the patients showed improvement in their physical condition compared with preoperative evaluations. However, general psychological adjustment declined after operation, with significant psychological hindrances to recovery occurring in approximately one third of the patients. On the average, patients tended to become more passive. Psychological hindrances at one year were anxiety, depression, poor self-esteem, passive dependency, somatic preoccupation, paranoid tendency, and withdrawal. Patients also had impaired sexual and marital functioning. A "high psychological risk" group was identified: patients with generally poor psychological adjustment, characterized preoperatively by disorganization, anxiety, paranoid tendency, hedonism, and high levels of psychologic activity. These patients were reluctant to undergo surgery despite a somatic preoccupation. Psychological prophylaxis and management should be addressed to specific patient needs.