Background: A successful cardiac surgery centre requires a lot of resources, skilled professionals, ancillary services and a defined patient population. Such centres are functional in super-specialty hospitals of big cities and is hard to reach for the rural poor. Hereby we are presenting the implementation process of a cardiac surgery centre in a rural tertiary care hospital and its successful service. Methods: our hospital is a 750 bedded tertiary care center with all specialties of medicine and is located in a rural area of Puducherry, India. We have cardiac cases reported from general medicine and general surgery. We built up team with a primary CT surgeon, an assistant surgeon, cardiac anesthesiologist, perfusionist, physician assistant, scrub nurses and the ICU & post operative ward nurses. Procurement of machines were made and was followed by setting up an operation theatre, ICU ward and post operative wards. Results: Our first case was an SVC type of Atrial Septal Defect, successfully operated on 21st April 2017. Till then we have completed 211 open heart procedures and our centre is getting advanced everyday. Conclusion: Establishing a cardiac surgery centre in a rural hospital setup is a challenging but feasible task. Emergence of such centers would help the rural community in terms of affordability and inconvenience in reaching super specialty centers of big cities.