Objective — to evaluate early and mid-term outcomes of different sternal closure techniques after cardiac surgery. Material and methods. This prospective, single-blinded trial randomized 126 patients at the time of sternal closure to either wire cerclage (WC, n=42), nitinol clips fixation (NCF, n=42) or cable-tie closure system (CTCS, n=42). The primary endpoints included intraoperative variables and sternal complications. Secondary endpoints included sternal healing at 3, 6, 12 months, was evaluated by using computed tomography and a 13-point scale; quality of life, was estimated by SF-36 questionnaires. Results. Nitinol clips fixation required fewer intraoperative time (33.6±11.1 min vs 43.7±18.8 min; p=0.003) and resulted in fewer postoperative blood loss (371±189 ml vs 455±184 ml; p=0.042) compared with wire cerclage. There were more deep sternal infections at the NCF group (14.3% vs 0% and 0%; p=0.026) compared with WC and CTCS groups. Cable-tie closure system and nitinol clips fixation resulted in better sternal healing scores at 6 (8.0±2.9 and 7.8±2.5 vs 6.1±2.4; p=0.004 and p=0.019 respectively) and 12 months (10.5±2.5 and 10.4±2.2 vs 8.8±3.1; p=0.011 and p=0.07 respectively) and greater scores of SF-36 questionnaires at 12 months with respect to all categories except for general health and social functioning (p<0.05) compared with wire cerclage. There were no significant differences between the CTCS and NCF groups with regard to sternal healing and any of the categories in SF-36. Conclusions. Sternal closure with cable-tie closure system and nitinol clips fixation resulted in significantly better sternal healing and quality of life compared with wire cerclage at 12 months after surgery. Nitinol clips fixation was fast technique and it resulted in fewer postoperative blood loss compared with wire cerclage but in cases when risk factors are presented it increased the rate of deep sternal infections.