the wearer has had open heart surgery
No i don't think that's it. lol The open or cracked heart tattoo symbolizes a broken heart, loss of a loved one , or to portray the feeling of sorrow
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A tattoo of a heart could just easily symbolize love of something.
Letting your heart soar...
Purple is the colour of passion and compassion. My purple heart wrist tattoo is to remind myself to lobe myself more
A dagger is a tattoo symbol that means an act of aggression. A rose is a symbol of love or beauty. These tattoo's together can mean that a loved one broke their heart and they are very upset about it.
The most common tattoo to accompany a heart is probably the rose. Music notes would also compliment the tattoo. A banner would also be classic.