Waste production and environmental impact in interventional cardiology: a lifecycle assessment and modelling study

Background and aims Percutaneous coronary interventions (PCI) and transcatheter-based valve therapies are performed with increasing frequency. However, the amount of waste generated during these procedures and the associated environmental burden remain largely unknown. Methods This prospective lifecycle assessment and modelling study was conducted at a tertiary center. Waste generated during ten cases of the five most common procedure types (diagnostic coronary angiography, PCI, complex PCI, transcatheter aortic valve implantation [TAVI], and transcatheter edge-to-edge repair [TEER]) was assessed. Procedural waste was classified into incinerable waste, paper/cardboard, recyclable plastics, hazardous medical waste, and sharps waste. A partial lifecycle assessment was performed focusing exclusively on the waste disposal phase to isolate the environmental burden attributable to waste treatment. Environmental footprint analysis was conducted using openLCA software with the ecoinvent database and the EF v3.1 method, integrating 16 environmental impact categories into a single normalized score (micropoints, µPt). Study endpoints were (1) total waste per procedure and distribution across waste categories, and (2) ecological footprint under three disposal models: waste separation (model 1), full municipal incineration (model 2), and full hazardous incineration (model 3). Results Across all procedures, median waste per case was 7.68 kg (IQR 4.72–14.37), ranging from 3.54 kg (IQR 3.42–3.88) for diagnostic coronary angiography to 17.51 kg (IQR 15.15–18.56) for TEER. Overall waste composition consisted predominantly of incinerable waste (70.8%). The environmental burden ranged from 246 µPt for diagnostic angiography to 724 µPt for TEER. Based on procedure volumes at the study center, the five analyzed procedure types generate an estimated total of 15.24 tons of waste annually. Scenario modelling demonstrated a strong association between disposal strategy and environmental burden. The ecological footprint per average procedure ranged from 477.95 µPt (15.85 kg CO₂-eq) to 506.76 µPt (16.59 kg CO₂-eq) and reached 1272.11 µPt (22.98 kg CO₂-eq) for models 1, 2, and 3, respectively. These values correspond to gasoline-vehicle travel equivalents of approximately 25.3 km, 26.9 km, and 67.4 km for models 1–3, respectively. Economic modelling showed similar trends (costs hazardous-only disposal vs. waste separation +422%). Extrapolation to Germany indicates that these procedure types generate approximately 4,022 tons of waste annually, and, even under waste separation, an environmental burden equivalent to driving nearly 22 million kilometres per year (≈544 Earth circumferences). Conclusion Interventional cardiology procedures generate substantial amounts of waste, and its disposal alone results in a measurable environmental footprint and CO₂ burden. Simple waste separation strategies can reduce environmental impact and costs.