Mega infrastructure projects (MIPs) have become increasingly important to the realization of sustainable development in China. Sustainable development is a process of dynamic balance, and coordinating the triple bottom line (the environmental, social, and economic dimensions) will enable more sustainable development of MIPs. However, previous studies have lacked consideration of coordination when applying sustainable development principles to the systematic identification of risks to MIPs. The goals of this study were to clarify the definition and dimensions of the sustainable development of MIPs and to identify the key risks of MIPs. A literature review was performed to extend the definition of sustainable development of MIPs by combining the triple bottom line with a fourth coordination dimension. A conceptual model of MIP risk identification was then proposed from an extended sustainable development perspective, 22 sustainability elements and 75 risk factors were identified, and the key risk factors were determined based on the interview responses and fuzzy set theory. The results show that economic risks have a high probability, social risks have a high loss, environmental risks have an intermediate probability and loss, and coordination risks have the greatest impact. In addition, the three most important key risk factors were found to be construction and installation cost overruns, land acquisition and resettling cost overruns, and information sharing with the public. Identifying key risk factors can provide information to help stakeholders understand the risk factors associated with MIPs and formulate reasonable risk response strategies.