Abstract: AIM To analyze risk factors for repeat sternotomy (RS) in adult cardiac surgery (CS) and to identify the impact on outcomes. METHODS A retrospective study was conducted by analyzing the data of 242 patients with RS of CS from September 2009 to September 2015 at the 55th Ward of Adult Cardiac Center in Fuwai Hospital. Continuous variables were analyzed using 2-sample t tests and categorical variables were compared using 2- or Fisher’s exact test. RESULTS Among the 242 patients, major injury (MI) occurred in 5 cases (2.1%) and no significant difference was found between the MI group and the non-MI group related to the interval since last sternotomy (8.3±5.0 years vs. 2.5±8.8 years, P=0.286). Occurrence rate of MI was not statistically different between the primary coronary artery bypass graft and other operations (6.3% vs. 1.8%, P=0.292), or between the pericardium had closed or not (0% vs. 7.4%, P=0.275). The operative mortality rate was 1.7% (4/242) and the operative mortality among the patients with MI during RS was not statistically different with those without MI (0% vs. 1.7%, P=0.919). CONCLUSION RS in adult CS is relatively safe and MI during RS is not a dangerous predictor of operative mortality.