Adaptation and distribution of cardioplegia practices in Thailand during the COVID-19 pandemic: insights from a nationwide survey

Background: Cardioplegia is essential for myocardial protection during cardiac surgery. The COVID-19 pandemic disrupted supply chains, affecting the availability of commercial cardioplegia solutions in Thailand and prompting institutions to modify their strategies. This study evaluates the distribution, selection, and adaptation of cardioplegia practices among Thai cardiac surgical centers during the pandemic. Methods: A nationwide survey was conducted in cardiac surgical centers performing ≥100 cases per year. Data on cardioplegia availability, usage, and preferences across different surgeries were collected via direct or telephone interviews with surgeons or perfusionists. Descriptive statistical analyses were applied. Results: St. Thomas-based cardioplegia remained the most widely used (95%), with 77.1% of institutions preparing custom formulations due to supply shortages. Histidine-tryptophan-ketoglutarate (HTK) was the second most used (76%), particularly in aortic and complex congenital surgeries, followed by del Nido cardioplegia (27%), often in modified formulations. Most centers (74%) used two to three cardioplegia solutions. Blood cardioplegia was preferred for coronary artery bypass grafting (89.2%) and valve procedures (78.4%), whereas HTK dominated in aortic (54.1%) and complex congenital surgeries (71.4%). Conclusion: Despite the pandemic, St. Thomas-based cardioplegia remained dominant in Thailand, with increasing reliance on HTK and modified del Nido cardioplegia. The widespread use of custom-made cardioplegia highlights the impact of supply chain disruptions. Post-pandemic studies are essential to evaluate long-term adaptations and refine myocardial protection strategies.