Application of Autologous Umbilical Cord Blood for Cardiopulmonary Bypass Priming in Neonatal Arterial Switch Operation for Transposition of the Great Arteries: A Overlap Weighting Analysis

Objective: This study aimed to evaluate the clinical value of priming the cardiopulmonary bypass (CPB) circuit with autologous umbilical cord blood (UCB) in neonatal cardiac surgery. Methods: This prospective clinical study included neonates who underwent surgical treatment for congenital heart disease at Guangdong Provincial People’s Hospital between September 2024 and November 2025. Patients who received autologous UCB for CPB priming were assigned to the UCB group. Neonates who received adult allogeneic blood (AAB) for CPB priming between 2021 and 2024 were selected as the control group. Preoperative baseline characteristics, intraoperative CPB and aortic cross-clamp (ACC) times, postoperative ICU stay, mechanical ventilation duration, biochemical and infection markers, echocardiographic findings, length of hospital stay, and postoperative complications were collected and compared between the two groups. Results: A total of 14 neonates with transposition of the great arteries (TGA) were included in the UCB group and 41 in the control group. After overlap weighting (OW), preoperative baseline characteristics were well balanced between the two groups (|SMD| < 0.10). Weighted analyses showed no significant differences in red blood cell count (RBC) or hemoglobin (Hb) levels at the end of surgery, nor in trends of blood gas parameters at the start of surgery, at the end of surgery, and 6 hours postoperatively (p > 0.05). However, the incidences of postoperative capillary leak syndrome (72.6 vs. 34.4%, p < 0.05) and chylothorax (54.9 vs. 15.9%, p < 0.05) were significantly higher in the UCB group, and chest drainage duration showed a near-significant trend toward prolongation (257 [140, 332] vs. 135 [115, 239], p = 0.074). Other outcomes, including maximum vasoactive-inotropic score within 48 hours (VIS), total hospital stay, mechanical ventilation time, ICU stay, and the incidence of other postoperative complications, did not differ significantly between the two groups. Conclusions: Priming CPB with autologous UCB substantially reduces the requirement for AAB and has minimal impact on postoperative cardiac recovery and homeostatic stability. This study provides preliminary evidence supporting the clinical application of autologous UCB for CPB priming, although larger studies are required to further validate its effectiveness.