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You'll only need to remember the recipe or discover a new one.
Items you come across on pedestals don't affect the crafting system either so seeing R Key in a Secret Room has no effect.
It's worth it. Bone Hearts can be spawned through careful T. Cain planning. Whether it be breaking apart a natural pedestal item in a Secret Room, using the D20 in one and spawning Golden Chests with items or the card Reversed Hierophant.
In the end, all you'll need is one Bone Heart and what will matter is the quality of your bag. Since R Key is Q4 you'll need components like Lucky Pennies, Golden Pickups and Soul Hearts along with the Bone Heart to have that greater chance of getting R Key.
Thank you for these explanations, good to know about the none effect on crafting pool. I haven't thought about using the D20 in the secret room, was more focused on the room with the more pickups I got in and wondering why I wasn't getting one...
During my second run, I'm not really sure, but I have found bones heart outside of the secret room, by taking boss item or something like this without using Chaos, don't really remember what happened but it seems possible to get some outside of the room