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Histidine-tryptophan-ketoglutarate (HTK) solution (modified), specifically known as Custodiol-N, is an advanced cardioplegic and organ preservation solution developed by Dr. Franz Koehler Chemie GmbH. It is an evolution of the original HTK (Bretschneider) solution, designed to enhance protection during cold ischemia and reperfusion. The solution operates as an intracellular-type cardioplegic agent, using low sodium and calcium concentrations to induce cardiac arrest in diastole. The modified version incorporates iron chelators (deferoxamine and LK-614) to mitigate oxidative stress and hydroxyl radical formation, and amino acids like glycine and alanine to stabilize cell membranes and prevent cold-induced injury. It is primarily indicated for myocardial protection during complex cardiac surgeries, such as those for congenital heart disease, and for the preservation of solid organs including the heart, kidney, liver, and lung during transplantation.
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