GREEN CATHeter Lab Study

Interventional cardiology procedures generate substantial amounts of waste, not only medical waste but also large volumes of packaging materials such as paper, cardboard, and plastic. In many hospitals, all procedural waste, regardless of type, is disposed of as medical waste. This practice results in high disposal costs and increased environmental burden, as medical waste requires specialized, energy-intensive incineration and leads to considerable CO₂ emissions. At the University Hospital Basel, waste is systematically separated into categories, enabling structured evaluation of waste streams and environmental impact. Despite growing interest in sustainable healthcare, there is currently a lack of data on the quantity and composition of waste generated per specific procedure type in interventional cardiology. This creates an unmet need to quantify not only how much waste is produced but also to identify which components may be recyclable. this study is to quantify the total amount and type of waste generated during interventional cardiovascular procedures and to contextualize this waste in relation to the average daily waste production of both a Swiss resident and a hospital inpatient. By linking procedural waste generation to familiar population-based benchmarks, This study aims to provide a comprehensible measure of the environmental footprint of each procedure type. Waste will be recorded in kilograms and categorized into four predefined waste streams (paper/cardboard, regular municipal waste, regulated medical waste, and recyclable plastic). To ensure representative and comparable results, at least ten cases for each of the following procedure groups will be included: (i) elective coronary angiography with (ia) or without (ib) percutaneous coronary intervention (PCI), (ii) complex PCI procedures, such as chronic total occlusions (CTO), complex high-risk indicated procedures (CHIP), or interventions performed in patients with cardiogenic shock requiring mechanical support (e.g., Impella), and (iii) structural heart interventions, including TAVI and (iv) TEER of the mitral or tricuspid valves (MitraClip or TriClip).

To assess the broader ecological and financial implications of current waste management practices, two comparative disposal models will be applied. The first, referred to as the "Basel Model", reflects the current institutional practice at the University Hospital Basel, where procedural waste is systematically separated into the four aforementioned categories at the point of care. The second, the "Standard Model", simulates a hypothetical but common practice in many hospitals, in which all waste generated during interventional procedures is disposed of as regulated medical waste, without separation.Based on these two models, the study will perform scenario-based calculations to compare the environmental and economic impact of both strategies.

Inclusion criteria

• All patients undergoing the following interventional procedures:

o Elective diagnostic coronary angiography

• with PCI
• without PCI

• Complex percutaneous coronary interventions (CTO, CHIP, or patients with cardiogenic shock requiring Impella support)
• Structural heart intervention: TAVI
• Structural heart interventions: TEER of the mitral or tricuspid valve (MitraClip or TriClip)

Exclusion criteria

• No exclusion criteria, as no patient-specific data are collected and no modifications to clinical care are introduced