Objective:To explore the related risk factors of secondary thoracotomy to stop bleeding after rheumatic heart disease valve replacement.Methods:A retrospective analysis of 373 patients in the Department of Cardiac Surgery of the First Hospital of Shanxi Medical University who underwent rheumatic heart disease valve replacement surgery from December 2013 to October 2020. According to whether or not to perform secondary thoracotomy to stop bleeding after operation, they were divided into two thoracotomy case group and control group. Collect the relevant clinical data of the patients, and analyze the risk factors that affect the second postoperative thoracotomy to stop bleeding through univariate and multivariate Logistic regression.Results:Among the 373 patients, 62 cases (16.62%) were in the secondary thoracotomy group and 311 cases (83.38%) were in the control group. Univariate analysis showed that the patient' s age, gender, prehospital cardiac function classification, pulmonary artery pressure, hemoglobin value (Hb), prothrombin time (PT), operation time, combined hypertension, intraoperative blood transfusion and postoperative two The occurrence of secondary thoracotomy to stop bleeding was related, and the difference was statistically significant ( P<0.05). The results of unconditional logistic regression analysis showed that prehospital cardiac function classification, Hb, PT, and hypertension are the risk factors leading to secondary thoracotomy to stop bleeding after rheumatic heart disease valve replacement. Conclusion:Effective control of risk factors can reduce the incidence of secondary thoracotomy after rheumatic heart disease valve replacement, and reduce the risk caused by secondary operations.