To evaluate the effect of autologous platelet-rich plasma (aPRP) on perioperative allogeneic blood product transfusion requirement in patients undergoing cyanotic congenital heart disease (CCHD) surgery and patients’ prognosis.

A retrospective cohort study.

A tertiary university hospital.

A total of 95 patients with CCHD who underwent cardiac surgery with cardiopulmonary bypass (CPB) between January 2020 and August 2025 were included, of whom 81 (85.3%) underwent redo operation.

Patients were divided into the aPRP group and the control group according to whether aPRP apheresis was employed. In the aPRP group, aPRP was harvested after anesthesia and transfused back to the patient after protamine neutralization, whereas the concurrently collected concentrated red blood cells (cRBCs) were reinfused during CPB or chest closure (from weaning from CPB to skin closure).

In the original cohort, the aPRP group had significantly lower packed red blood cell (PRBC) transfusion rates, as well as PRBC and fresh-frozen plasma (FFP) transfusion volume, than the control group. After propensity score matching, the intraoperative PRBC transfusion rate no longer differed significantly between groups (aPRP v control: 17.4% v 43.5%, p = 0.180). However, the PRBC transfusion volume remained significantly lower in the aPRP group, both as total volume (0 [0, 0] v 0 [0, 400] mL; p = 0.037) and as weight-adjusted volume (0 [0, 0] v 0 [0, 15.7] mL/kg; p = 0.045). The matched intraoperative FFP transfusion requirements were also significantly reduced in the aPRP group (200 [0, 600] v 600 [400, 1,000] mL, p < 0.05). Viscoelastic testing indicated significantly improved coagulation and platelet function following aPRP administration in the treatment group. No difference in intraoperative blood loss, postoperative allogeneic blood products, 24-hour chest tube drainage, use of coagulation agents, postoperative ventilation time, or intensive care unit stay was observed.

In a predominantly redo cohort of patients with CCHD undergoing cardiac surgery, the use of aPRP was associated with reduced intraoperative allogeneic blood and plasma transfusion requirements, and it also effectively preserved hemostatic function in these patients. However, the reduction in allogeneic product use may not be primarily due to the preserved hemostatic function conferred by aPRP but rather to autologous substitution of allogeneic products.