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López-Muñoz P, Martín-Cabezuelo R, Lorenzo-Zúñiga V, García-Castellanos M, Vilariño-Feltrer G, Tort-Ausina I, Campillo-Fernández A, Pons Beltrán V. Environmental footprint and material composition comparison of single-use and reusable duodenoscopes. Endoscopy 2024. [PMID: 38986490 DOI: 10.1055/a-2364-1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND Infection outbreaks associated with contaminated reusable duodenoscopes (RUDs) have induced the development of novel single-use duodenoscopes (SUDs). This study aimed to analyze the material composition and life cycle assessment (LCA) of RUDs and SUDs to assess the sustainability of global and partial SUD implementation. METHODS A single-center study evaluated material composition analysis and LCA of one RUD and two SUDs from different manufacturers (A/B). Material composition analysis was performed to evaluate the thermochemical properties of the duodenoscope components. The carbon footprint was calculated using environmental software. We compared the sustainability strategies of universal use of RUDs, frequent use of RUDs with occasional SUDs, and universal use of SUDs over the lifetime of one RUD. RESULTS RUDs were substantially heavier (3489 g) than both SUD-A (943 g) and SUD-B (716 g). RUDs were mainly metal alloys (95%), whereas SUDs were mainly plastic polymers and resins (70%-81%). The LCA demonstrated the sustainability of RUDs, with a life cycle carbon footprint 62-82 times lower than universal use of SUDs (152 vs. 10 512-12 640 kg CO2eq) and 10 times lower than occasional use of SUDs (152 vs. 1417-1677 kg CO2eq). Differences were observed between SUD-A and SUD-B (7.9 vs. 6.6 kg CO2eq per endoscope). End-of-life incineration emissions for SUDs were the greatest environmental contributors. CONCLUSIONS Widespread adoption of SUDs has greater environmental challenges; it requires a balance between infection control and environmental responsibility. Carbon footprint labelling can help healthcare institutions make sustainable choices and promote environmentally responsible healthcare practices.
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Affiliation(s)
- Pedro López-Muñoz
- Gastroenterology and Endoscopy / IIS La Fe, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Rubén Martín-Cabezuelo
- Centre for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
| | - Vicente Lorenzo-Zúñiga
- Gastroenterology and Endoscopy / IIS La Fe, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medicine, Valencia Catholic University Saint Vincent Martyr Faculty of Medicine and Dentistry, Valencia, Spain
| | - Marina García-Castellanos
- Gastroenterology and Endoscopy / IIS La Fe, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Guillermo Vilariño-Feltrer
- Centre for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
| | - Isabel Tort-Ausina
- Centre for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
- CIBER de Bioingenieria, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Campillo-Fernández
- Centre for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
| | - Vicente Pons Beltrán
- Gastroenterology and Endoscopy / IIS La Fe, La Fe University and Polytechnic Hospital, Valencia, Spain
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Stevenin G, Canonge J, Gervais M, Fiore A, Lareyre F, Touma J, Desgranges P, Raffort J, Sénémaud J. e-Health and environmental sustainability in vascular surgery. Semin Vasc Surg 2024; 37:333-341. [PMID: 39277350 DOI: 10.1053/j.semvascsurg.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 09/17/2024]
Abstract
e-Health technology holds great promise for improving the management of patients with vascular diseases and offers a unique opportunity to mitigate the environmental impact of vascular care, which remains an under-investigated field. The innovative potential of e-Health operates in a complex environment with finite resources. As the expansion of digital health will increase demand for devices, contributing to the environmental burden of electronics and energy use, the sustainability of e-Health technology is of crucial importance, especially in the context of increasing prevalence of cardiovascular diseases. This review discusses the environmental impact of care related to vascular surgery and e-Health innovation, the potential of e-Health technology to mitigate greenhouse gas emissions generated by the health care sector, and to provide leads to research promoting e-Heath technology sustainability. A multifaceted approach, including ethical design, validated eco-audits methodology and reporting standards, technological refinement, electronic and medical devices reuse and recycling, and effective policies is required to provide a sustainable and optimal level of care to vascular patients.
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Affiliation(s)
- Gabrielle Stevenin
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Jennifer Canonge
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Marianne Gervais
- Université Paris-Est, Créteil, France; Institut Mondor de Recherche Biomédicale, U955 INSERM, Créteil, France
| | - Antonio Fiore
- Université Paris-Est, Créteil, France; Department of Cardiac Surgery, Henri Mondor University Hospital, Créteil, France
| | - Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France,; Université Côte d'Azur, Le Centre National de la Recherche Scientifique, UMR7370, LP2M, Nice, France; Fédération Hospitalo-Universitaire Plan&Go, Nice, France
| | - Joseph Touma
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France
| | - Juliette Raffort
- Université Côte d'Azur, Le Centre National de la Recherche Scientifique, UMR7370, LP2M, Nice, France; Fédération Hospitalo-Universitaire Plan&Go, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France
| | - Jean Sénémaud
- Department of Vascular Surgery, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000 Créteil, France; Université Paris-Est, Créteil, France; Laboratory for Vascular Translational Science, U1148 INSERM, Paris, France.
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Malhi JK, McEvoy JW, Blumenthal RS, Jacobsen AP. Climate change and cardiovascular health: Recent updates and actions for healthcare. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 45:100443. [PMID: 39246679 PMCID: PMC11377132 DOI: 10.1016/j.ahjo.2024.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024]
Abstract
Climate change is a public health crisis predominantly due to fossil fuel combustion, that challenges planetary and human health. Considerable evidence exists to demonstrate the impact climate change has on cardiovascular disease primarily through air pollution, and non-optimal temperature. Conversely, healthcare systems themselves contribute substantially to climate change. Many clinicians personally report a sense of responsibility to reduce the detrimental impact of parts of our healthcare system on the environment. Roadmaps exist to guide decarbonization and reduce pollution in the healthcare sector. The first step in minimizing the climate impact of the provision of cardiovascular care is to determine the carbon footprint of highly resource dependent sectors such as critical care cardiology as well as the cardiac catheterization and electrophysiology laboratories. This should be followed by sustainable changes to address healthcare waste and energy use. Engagement from healthcare leadership, governmental organizations and major cardiac societies will be necessary to impact meaningful change.
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Affiliation(s)
- Jasmine K Malhi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- University of Galway and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
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Gorgun E, Dehipawala S, O’Hara M, Naoumtchik E, Gangoli G, Ricketts C, Tommaselli GA. Environmental Sustainability Initiatives in the Operating Room: A Scoping Review. ANNALS OF SURGERY OPEN 2024; 5:e451. [PMID: 39310357 PMCID: PMC11415109 DOI: 10.1097/as9.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/17/2024] [Indexed: 09/25/2024] Open
Abstract
The global healthcare industry has a substantial environmental footprint and therefore has a responsibility to decrease its impact. Changes to increase sustainability will only occur if healthcare providers (HCPs) and decision-makers understand and incorporate environmentally conscious practices in the operating room (OR). This scoping review aimed to assess hospital initiatives undertaken to support environmental sustainability in the OR, with a focus on HCP and hospital decision-maker beliefs and perceptions related to sustainability. A scoping review was conducted using Embase and PubMed. Searches were performed to identify relevant studies published between January 2011 and November 2022. A total of 163 publications were included: 10 systematic literature reviews and 153 original research articles. Most studies reported department-wide sustainability measures (waste reduction, staff education, etc), which were evaluated by the reduction in generated waste and energy, emission of greenhouse gasses, and costs. Despite up to 97% of HCPs noting willingness to improve sustainability within practices, up to 80.9% of HCPs stated that they lacked the necessary training and information. In conclusion, this research highlights a recent increase in interest about sustainability initiatives in the OR and that HCPs and surgical staff are not only willing to participate but also have suggestions on how to minimize the environmental impact of the OR.
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Affiliation(s)
- Emre Gorgun
- From the Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Sumudu Dehipawala
- Evidence, Value, Access & Pricing, Trinity Life Sciences, Waltham, MA
| | - Matthew O’Hara
- Evidence, Value, Access & Pricing, Trinity Life Sciences, Waltham, MA
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Di Felici F, Maestri F, Bodaghi B. The carbon footprint of French hospital ophthalmology consultations. Eye (Lond) 2024:10.1038/s41433-024-03257-0. [PMID: 39068249 DOI: 10.1038/s41433-024-03257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 06/21/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND France carbon footprint, with 604 million tons of CO2 equivalent (CO2eq) annual emissions, far exceeds the worldwide scientific specifications to not exceed 2 °C of warming in 2100. The healthcare sector is one of the biggest contributors to greenhouse gas emissions. The aim of this study is to quantify and evaluate the carbon footprint of the consultation activity of an ophthalmology department at a single institution in France. METHODS The perimeter of the investigation included consultations and excluded the surgeries and the hospitalisation. We calculated the carbon footprint of a single day of practice in our scope of investigation. We included consumption of energy, patient travel, staff travel, pharmaceutics and medical devices purchases, computer hardware, biomedical equipment/exam materials, and waste. We used the official French public database of emission factors: Base Empreinte® of the Environmental and Energy Management Agency of France. RESULTS The carbon footprint of a single day of our department was estimated at 1 688.65 kgCO2eq. It represents an average of 9.28 kgCO2eq per patient. Energy consumption contributed for 114.80 kgCO2eq (6.8%), travel for 1324.76 kgCO2eq (78.4%), pharmaceutics and medical devices for 208.33 kgCO2eq (12.3%), equipment for 14.38 kgCO2eq (0.9%) and waste for 26.38 kgCO2eq (1.6%). CONCLUSIONS This study highlights the importance of patient travels, and possibly pharmaceutics, in the carbon footprint of hospital ophthalmology practice in France. More studies are needed to establish it at the national or international scale, as well as more carbon footprint analyses on products, especially those of high prices, to increase the accuracy of these studies.
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Affiliation(s)
- Fabien Di Felici
- Department of Ophthalmology, La Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Federico Maestri
- Department of Ophthalmology, La Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, La Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
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Pioche M, Cunha Neves JA, Pohl H, Lê MQ, Grau R, Dray X, Yzet C, Mochet M, Jacques J, Wallenhorst T, Rivory J, Siret N, Peillet AL, Chevaux JB, Mion F, Chaput U, Jacob P, Grinberg D, Saurin JC, Baddeley R, Rodriguez de Santiago E, Cottinet PJ. The environmental impact of small-bowel capsule endoscopy. Endoscopy 2024. [PMID: 38657660 DOI: 10.1055/a-2313-5142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), is a topic of growing attention and concern. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO2) generated by an SBCE procedure. METHODS Life cycle assessment methodology (ISO 14040) was used to evaluate three brands of SBCE device and included emissions generated by patient travel, bowel preparation, capsule examination, and video recording. A survey of 87 physicians and 120 patients was conducted to obtain data on travel, activities undertaken during the procedure, and awareness of environmental impacts. RESULTS The capsule itself (4 g) accounted for < 6 % of the total product weight. Packaging (43-119 g) accounted for 9 %-97 % of total weight, and included deactivation magnets (5 g [4 %-6 %]) and paper instructions (11-50 g [up to 40 %]). A full SBCE procedure generated approximately 20 kgCO2, with 0.04 kgCO2 (0.2 %) attributable to the capsule itself and 18 kgCO2 (94.7 %) generated by patient travel. Capsule retrieval using a dedicated device would add 0.98 kgCO2 to the carbon footprint. Capsule deconstruction revealed materials (e. g. neodymium) that are prohibited from environmental disposal; 76 % of patients were not aware of the illegal nature of capsule disposal via wastewater, and 63 % would have been willing to retrieve it. The carbon impact of data storage and capsule reading was negligible. CONCLUSION The carbon footprint of SBCE is mainly determined by patient travel. The capsule device itself has a relatively low carbon footprint. Given that disposal of capsule components via wastewater is illegal, retrieval of the capsule is necessary but would likely be associated with an increase in device-related emissions.
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Affiliation(s)
- Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Joao A Cunha Neves
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
| | - Heiko Pohl
- Departments of Gastroenterology, VA Medical Center, White River Junction, Vermont; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Minh-Quyen Lê
- Material Analysis Laboratory, INSA Lyon, Villeurbanne, France
| | - Raphaelle Grau
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, University Hospital, Amiens, France
| | - Mikael Mochet
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Timothée Wallenhorst
- Gastroenterology and Endoscopy Unit, University Hospital Pontchaillou, Rennes, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nadège Siret
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Anne-Laure Peillet
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - François Mion
- Digestive Physiology Department, Hospices Civils de Lyon, Lyon, France
| | - Ulriikka Chaput
- Sorbonne University, Centre for Digestive Endoscopy, Hôpital Saint-Antoine, APHP, Paris, France
| | - Philippe Jacob
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Gastroenterology and Endoscopy Unit, Nimes Private Clinic, Nimes, France
| | - Daniel Grinberg
- Material Analysis Laboratory, INSA Lyon, Villeurbanne, France
- Cardiac Surgery, Cardiologic Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Saurin
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Robin Baddeley
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute; King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital; and Imperial College London, London, UK
| | - Enrique Rodriguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain
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7
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Gunasekaran S, Szava-Kovats A, Battey T, Gross J, Picano E, Raman SV, Lee E, Bissell MM, Alasnag M, Campbell-Washburn AE, Hanneman K. Cardiovascular Imaging, Climate Change, and Environmental Sustainability. Radiol Cardiothorac Imaging 2024; 6:e240135. [PMID: 38900024 PMCID: PMC11211952 DOI: 10.1148/ryct.240135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Environmental exposures including poor air quality and extreme temperatures are exacerbated by climate change and are associated with adverse cardiovascular outcomes. Concomitantly, the delivery of health care generates substantial atmospheric greenhouse gas (GHG) emissions contributing to the climate crisis. Therefore, cardiac imaging teams must be aware not only of the adverse cardiovascular health effects of climate change, but also the downstream environmental ramifications of cardiovascular imaging. The purpose of this review is to highlight the impact of climate change on cardiovascular health, discuss the environmental impact of cardiovascular imaging, and describe opportunities to improve environmental sustainability of cardiac MRI, cardiac CT, echocardiography, cardiac nuclear imaging, and invasive cardiovascular imaging. Overarching strategies to improve environmental sustainability in cardiovascular imaging include prioritizing imaging tests with lower GHG emissions when more than one test is appropriate, reducing low-value imaging, and turning equipment off when not in use. Modality-specific opportunities include focused MRI protocols and low-field-strength applications, iodine contrast media recycling programs in cardiac CT, judicious use of US-enhancing agents in echocardiography, improved radiopharmaceutical procurement and waste management in nuclear cardiology, and use of reusable supplies in interventional suites. Finally, future directions and research are highlighted, including life cycle assessments over the lifespan of cardiac imaging equipment and the impact of artificial intelligence tools. Keywords: Heart, Safety, Sustainability, Cardiovascular Imaging Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Suvai Gunasekaran
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Andrew Szava-Kovats
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Thomas Battey
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Jonathan Gross
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Eugenio Picano
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Subha V. Raman
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Emil Lee
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Malenka M. Bissell
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Mirvat Alasnag
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Adrienne E. Campbell-Washburn
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Kate Hanneman
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
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8
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Sacher F, Bacquelin R, Bessiere F, Ditac G, Duchateau J, Ait-Said M, Boveda S, Extramiana F, Delsarte L, Fauchier L, Gandjbakhch E, Garcia R, Klug D, Lellouche N, Marijon E, Martins R, Maury P, Mette C, Piot O, Taieb J, Defaye P. Position paper on sustainability in cardiac pacing and electrophysiology from the Working Group of Cardiac Pacing and Electrophysiology of the French Society of Cardiology. Arch Cardiovasc Dis 2024; 117:224-231. [PMID: 38302391 DOI: 10.1016/j.acvd.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
Sustainability in healthcare, particularly within the domain of cardiac electrophysiology, assumes paramount importance for the near future. The escalating environmental constraints encountered necessitate a proactive approach. This position paper aims to raise awareness among physicians, spark critical inquiry and identify potential solutions to enhance the sustainability of our practice. Reprocessing of single-use medical devices has emerged as a potential solution to mitigate the environmental impact of electrophysiology procedures, while also offering economic advantages. However, reprocessing remains unauthorized in certain countries. In regions where it is possible, stringent regulatory standards must be adhered to, to ensure patient safety. It is essential that healthcare professionals, policymakers and manufacturers collaborate to drive innovation, explore sustainable practices and ensure that patient care remains uncompromised in the face of environmental challenges. Ambitious national/international programmes of disease prevention should be the cornerstone of the strategy. It is equally vital to implement immediate actions, as delineated in this position paper, to bring about tangible change quickly.
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Affiliation(s)
- Frédéric Sacher
- Cardiac Arrhythmia Department, Bordeaux University Hospital, 33000 Bordeaux, France; Inserm U 1045, IHU Liryc, CRCTB, université de Bordeaux, 33000 Bordeaux, France.
| | | | - Francis Bessiere
- Hospices civils de Lyon, hôpital cardiovasculaire Louis-Pradel, 69500 Bron, France; Inserm, LabTau U1032, université Claude-Bernard Lyon 1, 69003 Lyon, France
| | - Geoffroy Ditac
- Hospices civils de Lyon, hôpital cardiovasculaire Louis-Pradel, 69500 Bron, France
| | - Josselin Duchateau
- Cardiac Arrhythmia Department, Bordeaux University Hospital, 33000 Bordeaux, France; Inserm U 1045, IHU Liryc, CRCTB, université de Bordeaux, 33000 Bordeaux, France
| | | | - Serge Boveda
- Heart Rhythm Management Department, clinique Pasteur, 31076 Toulouse, France; Vrije Universiteit Brussel (VUB), 1090 Jette, Brussels, Belgium; Inserm U970, 75908 Paris, France
| | - Fabrice Extramiana
- Cardiologie, université Paris Cité, hôpital Bichat, AP-HP, 75018 Paris, France
| | - Laura Delsarte
- Service de cardiologie, CHU de Montpellier, 34295 Montpellier, France
| | - Laurent Fauchier
- Service de cardiologie, CHU de Trousseau, 37170 Chambray-lès-Tours, France; Faculté de médecine, université François-Rabelais, 37032 Tours, France
| | - Estelle Gandjbakhch
- Cardiology Department, ICAN, Sorbonne université, Pitié-Salpêtrière University Hospital, AP-HP, 75013 Paris, France
| | - Rodrigue Garcia
- Cardiology Department, entre d'investigation CIC14-02, CHU de Poitiers, 86000 Poitiers, France
| | - Didier Klug
- Service de cardiologie, CHU de Lille, 59000 Lille, France
| | - Nicolas Lellouche
- Service de cardiologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Eloi Marijon
- Service de cardiologie, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Raphael Martins
- Inserm, LTSI - UMR 1099, CHU de Rennes, université de Rennes, 35000 Rennes, France
| | - Philipe Maury
- Unité Inserm U 1048, Department of Cardiology, University Hospital Rangueil, 31400 Toulouse, France
| | - Carole Mette
- Centre cardiologique du Nord Saint-Denis, 93207 Saint-Denis, France
| | - Olivier Piot
- Centre cardiologique du Nord Saint-Denis, 93207 Saint-Denis, France
| | - Jerome Taieb
- Service de cardiologie, centre hospitalier du Pays d'Aix, 13100 Aix-en-Provence, France
| | - Pascal Defaye
- Cardiology Department, Grenoble-Alpes University, University Hospital, 38043 Grenoble, France
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9
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Kataoka S, Shoda M, Ejima K, Kato K, Yazaki K, Hasegawa S, Sakai M, Higuchi S, Yagishita D, Yamaguchi J. Hybrid ablation for persistent atrial fibrillation: a narrative review. J Thorac Dis 2024; 16:1702-1714. [PMID: 38505041 PMCID: PMC10944770 DOI: 10.21037/jtd-23-1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024]
Abstract
Background and Objective Treatment for atrial fibrillation (AF) has evolved significantly, with pulmonary vein isolation (PVI) becoming an established treatment. However, the outcomes following catheter ablation for persistent AF remain unsatisfactory. Hybrid catheter-surgical ablation has emerged as a therapeutic approach for persistent AF, combining the strengths of both interventions. The purpose of this narrative review is to comprehensively examine the current state of knowledge regarding hybrid ablation for AF. Methods A thorough PubMed search using the terms "hybrid ablation", "atrial fibrillation", "catheter ablation", and "guideline on cardiology" within the timeframe of 1980 to 2024 resulted in 138,969 articles. Consensus on the selected articles was reached through a series of structured meetings and discussions. Key Content and Findings PVI has demonstrated higher sinus rhythm maintenance rates, especially for paroxysmal AF. However, the efficacy is not as high for persistent AF. Additional ablation strategies, such as linear ablation, complex fractionated atrial electrogram ablation, low voltage zone ablation as well as posterior wall isolation, lack consistent evidence of effectiveness. Hybrid ablation, involving collaboration between cardiac surgeons and electrophysiologists, presents a promising alternative for hard-to-treat AF. Recent studies report favorable outcomes of hybrid ablation, with atrial arrhythmia-free rates ranging from 53.5% to 76%, surpassing those of catheter ablation alone, which might result from better lesion durability or intervention for non-PV foci and left atrial appendage excision or closure during hybrid ablation. The rate of complications associated with hybrid ablation is higher than catheter ablation alone. Conclusions While favorable outcomes of hybrid ablation for persistent AF have been reported, it is not recommended for all AF patients due to its invasiveness compared to catheter ablation. Additionally, some patients with persistent AF maintain sinus rhythm with catheter ablation alone. More clinical data are needed to determine which patients are suitable candidates for hybrid ablation.
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Affiliation(s)
- Shohei Kataoka
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Koichiro Ejima
- Department of Cardiology, Minamino Cardiology Hospital, Tokyo, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Shun Hasegawa
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masayuki Sakai
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
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10
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Martín-Cabezuelo R, Vilariño-Feltrer G, Campillo-Fernández AJ, Lorenzo-Zúñiga V, Pons V, López-Muñoz P, Tort-Ausina I. Materials Science Toolkit for Carbon Footprint Assessment: A Case Study for Endoscopic Accessories of Common Use. ACS ENVIRONMENTAL AU 2024; 4:42-50. [PMID: 38250342 PMCID: PMC10797683 DOI: 10.1021/acsenvironau.3c00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Ironically, healthcare systems are key agents in respiratory-related diseases and estimated deaths because of the high impact of their greenhouse gas emissions, along with industry, transportation, and housing. Based on safety requirements, hospitals and related services use an extensive number of consumables, most of which end up incinerated at the end of their life cycle. A thorough assessment of the carbon footprint of such devices typically requires knowing precise information about the manufacturing process, which is rarely available in detail because of the many materials, pieces, and steps involved during the fabrication. Yet, the tools most often used for determining the environmental impact of consumer goods require a bunch of parameters, mainly based on the material composition of the device. Here, we report a basic set of analytical methods that provide the information required by the software OpenLCA to calculate the main outcome related to environmental impact, greenhouse gas emissions. Through thermogravimetry, calorimetry, infrared spectroscopy, and elemental analysis, we proved that obtaining relevant data for the calculator in the exemplifying case of endoscopy tooling or accessories is possible. This routine procedure opens the door to a broader, more accurate analysis of the environmental impact of everyday work at hospital services, offering potential alternatives to minimize it.
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Affiliation(s)
- Rubén Martín-Cabezuelo
- Centre
for Biomaterials and Tissue Engineering, CBIT, Universitat Politècnica de València, 46022 València, Spain
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Guillermo Vilariño-Feltrer
- Centre
for Biomaterials and Tissue Engineering, CBIT, Universitat Politècnica de València, 46022 València, Spain
| | | | - Vicente Lorenzo-Zúñiga
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Vicente Pons
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Pedro López-Muñoz
- Department
of Gastroenterology, La Fe Health Research
Institute—IIS La Fe, 46026 València, Spain
| | - Isabel Tort-Ausina
- Centre
for Biomaterials and Tissue Engineering, CBIT, Universitat Politècnica de València, 46022 València, Spain
- CIBER-BBN,
ISCIII, 46022 València, Spain
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11
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Ditac G, Schweizer R, Cottinet PJ, Bessière F. Impact of maintenance anaesthetics on total emissions of an atrial fibrillation catheter ablation procedure-Authors' reply. Europace 2023; 25:euad355. [PMID: 38016161 PMCID: PMC10751808 DOI: 10.1093/europace/euad355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Geoffroy Ditac
- Department ofElectrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lépine, 69500 Bron, France
| | - Rémi Schweizer
- Department of Anesthesia and ICU, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | | | - Francis Bessière
- Department ofElectrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lépine, 69500 Bron, France
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12
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Trecourt A, Cottinet PJ, Donzel M, Favretto M, Bancel B, Decaussin-Petrucci M, Traverse-Glehen A, Devouassoux-Shisheboran M, Meyronet D, Belleannée G, Rullier A, Lê MQ, Rival G, Grinberg D, Tilmant C, Gaillot-Durand L. Carbon footprint evaluation of routine anatomic pathology practices using eco-audit: Current status and mitigation strategies. Ann Diagn Pathol 2023; 67:152210. [PMID: 37734347 DOI: 10.1016/j.anndiagpath.2023.152210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Alexis Trecourt
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud Charles Mérieux, UR 3738, CICLY, Lyon, France.
| | - Pierre-Jean Cottinet
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France
| | - Marie Donzel
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR 5286, Lyon, France
| | - Marion Favretto
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France
| | - Béatrice Bancel
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France
| | - Myriam Decaussin-Petrucci
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR 5286, Lyon, France
| | - Alexandra Traverse-Glehen
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR 5286, Lyon, France
| | - Mojgan Devouassoux-Shisheboran
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, CRCL, INSERM U1052, CNRS UMR 5286, Lyon, France
| | - David Meyronet
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, CRCL, INSERM U1052, CNRS UMR 5286, Lyon, France
| | | | - Anne Rullier
- CHU de Bordeaux, Hôpital Pellegrin, Service de Pathologie, Bordeaux, France
| | - Minh-Quyen Lê
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France
| | - Guilhem Rival
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France
| | - Daniel Grinberg
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France; Hospices Civils de Lyon, Hôpital cardiologique « Louis Pradel », Service de chirurgie cardiaque, Lyon, France
| | - Cyprien Tilmant
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Pathologie, Lille, France
| | - Lucie Gaillot-Durand
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France
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13
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Robinson PN, Surendran KSB, Lim SJ, Robinson M. The carbon footprint of surgical operations: a systematic review update. Ann R Coll Surg Engl 2023; 105:692-708. [PMID: 37906978 PMCID: PMC10626532 DOI: 10.1308/rcsann.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Sustainability in healthcare is a rapidly developing area of research with recent formal recognition from institutions around the world. We completed an update of a systematic review published in 2020. The aims of this review were to determine the reported carbon footprints of surgical operations in hospitals worldwide, identify variations in reported carbon footprints and highlight carbon hotspots associated with surgery. METHODS A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The MEDLINE®, Embase® and Cochrane Library databases were searched, and eligibility criteria applied. The study characteristics, scope of product inventory and results were extracted and synthesised. A quality assessment of each study was completed to inform the reliability of the research. RESULTS 1,308 articles were identified and 7 met the inclusion criteria for the review. The carbon footprint ranged from 28.49kg to 505.1kg carbon dioxide equivalents (CO2e). Medical devices and consumables were the greatest contributor to emissions, with material production and manufacture representing the majority of this carbon hotspot. There were significant methodological limitations and a lack of consistency in carbon footprint calculations between studies. CONCLUSIONS This systematic review identifies medical devices and consumables as the largest carbon hotspot where healthcare providers should target their sustainability initiatives. Nevertheless, the number of studies was limited and the quality of the evidence was weak. We recommend that researchers in healthcare sustainability develop international standards for conducting and reporting such studies. This would allow for comparison of individual studies and facilitate meta-analysis of cumulative evidence. A reliable evidence base is a prerequisite for identifying optimal interventions to ensure societal benefits.
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Affiliation(s)
| | | | - SJ Lim
- St George’s University Hospitals NHS Foundation Trust, UK
| | - M Robinson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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14
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Kalmar AF, Mulier H, Verdonck P. Impact of maintenance anaesthetics on total emissions of an atrial fibrillation catheter ablation procedure. Europace 2023; 25:euad291. [PMID: 37738424 PMCID: PMC10558057 DOI: 10.1093/europace/euad291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Alain F Kalmar
- Department of Electronics and Information Systems, IBiTech, Ghent University, Technologiepark-Zwijnaarde 126, 9052 Gent, Belgium
- Department of Anesthesia and Critical Care, AZ Sint-Jan Brugge Oostende AV, Bruges, Belgium
| | - Harold Mulier
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Pascal Verdonck
- Department of Electronics and Information Systems, IBiTech, Ghent University, Technologiepark-Zwijnaarde 126, 9052 Gent, Belgium
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15
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López-Muñoz P, Martín-Cabezuelo R, Lorenzo-Zúñiga V, Vilariño-Feltrer G, Tort-Ausina I, Vidaurre A, Pons Beltran V. Life cycle assessment of routinely used endoscopic instruments and simple intervention to reduce our environmental impact. Gut 2023; 72:1692-1697. [PMID: 37185655 DOI: 10.1136/gutjnl-2023-329544] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES GI endoscopy units represent the third largest producers of medical waste. We aimed to determine endoscopic instrument composition and life cycle assessment (LCA) and to assess a sustainability proposal based on a mark on the instruments that identifies parts can be safely recycled or 'green mark'. DESIGN Material composition analysis and LCA of forceps, snares and clips from four different manufacturers (A-D) were performed with four different methods. Carbon footprint from production, transportation and end of life of these instruments was calculated. In 30 consecutive procedures, we marked the contact point with the working channel. 5 cm away from that point was considered as green mark. One-week prospective study was conducted with 184 procedures evaluating 143 instruments (75 forceps, 49 snares and 19 haemoclips) to assess the efficacy of this recyclable mark. RESULTS Composition from different manufacturers varied widely. Most common materials were high global warming potential (GWP) waste (polyethylene, polypropylene and acrylonitrile) and low GWP waste (stainless steel). Significant differences were found for the forceps (0.31-0.47 kg of CO2 equivalent (CO2-eq)) and haemoclips (0.41-0.57 kg CO2-eq) between the manufacturers. Green mark was established 131.26 cm for gastroscope and 195.32 cm for colonoscope. One-week activity produced 67.74 kg CO2-eq. Applying our sustainability intervention, we could reduce up to 27.44% (18.26 kg CO2-eq). This allows the recycling of 61.7% of the instrument total weight (4.69 kg). CONCLUSION Knowledge of carbon footprint is crucial to select the most sustainable alternatives because there are large variations between brands. A mark to identify recyclable parts could reduce our environmental impact significantly.
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Affiliation(s)
- Pedro López-Muñoz
- Department of Gastroenterology, La Fe Health Research Institute - IIS La Fe, Valencia, Spain
| | - Rubén Martín-Cabezuelo
- Department of Gastroenterology, La Fe Health Research Institute - IIS La Fe, Valencia, Spain
- Center for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
| | - Vicente Lorenzo-Zúñiga
- Department of Gastroenterology, La Fe Health Research Institute - IIS La Fe, Valencia, Spain
| | - Guillermo Vilariño-Feltrer
- Center for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
| | - Isabel Tort-Ausina
- Center for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
- CIBER-BBN, ISCIII, Spain
| | - Ana Vidaurre
- Center for Biomaterials and Tissue Engineering (CBIT), Universitat Politècnica de València, Valencia, Spain
- CIBER-BBN, ISCIII, Spain
| | - Vicente Pons Beltran
- Department of Gastroenterology, La Fe Health Research Institute - IIS La Fe, Valencia, Spain
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Bawa D, Ahmed A, Darden D, Kabra R, Garg J, Bansal S, Olsen E, Atkins D, Rahim A, Pham N, Gopinathannair R, Pothineni NVK, Park P, Tummala R, Koerber S, Natale A, Lakkireddy D. Impact of Remote Cardiac Monitoring on Greenhouse Gas Emissions: Global Cardiovascular Carbon Footprint Project. JACC. ADVANCES 2023; 2:100286. [PMID: 38939591 PMCID: PMC11198686 DOI: 10.1016/j.jacadv.2023.100286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 06/29/2024]
Abstract
Background Remote monitoring (RM) of patients with cardiac implantable electronic devices (CIEDs) is efficient and requires fewer resources than conventional monitoring. However, the impact of RM on the carbon footprint (CF) is not known. Objectives The authors sought to evaluate the reduction in cost and greenhouse gas (GHG) emissions with RM as compared to conventional monitoring of CIEDs and its relevance to CF. Methods Data were obtained from a third-party RM provider on 32,811 patients from 67 device clinics across the United States. Distance from home address to the device clinic for patients on RM was calculated. Savings in total distance traveled over 2 years was calculated using frequency of follow-up required for the device type. National fuel efficiency data and carbon emission data were obtained from the Bureau of Transportation Statistics and U.S. Environmental Protective Agency, respectively. The average gas price during the study period was obtained from U.S. Energy Information Administration. Results In the study population, RM resulted in a total saving of 31.7 million travel miles at $3.45 million and reduction of 12,518 metric ton of GHG from gasoline. There was a reduction of 14.2-million-page printouts, $3 million in cost, and 78 tons of GHG. Improvement in workforce efficiency with RM resulted in savings of $3.7 million. There was a net saving of $10.15 million and 12,596 tons of GHG emissions. Conclusions RM of patients with a CIED resulted in significant reductions in GHG emissions. Efforts to actively promoting RM can result in significant reduction in CF.
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Affiliation(s)
- Danish Bawa
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Shanti Bansal
- Houston Heart Rhythm and Octagos Health, Houston, Texas, USA
| | - Eric Olsen
- Houston Heart Rhythm and Octagos Health, Houston, Texas, USA
| | - Donita Atkins
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Anam Rahim
- Division of School of Nursing, University of Texas Medical Branch, Galveston, Texas, USA
| | - Nicholas Pham
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | | | - Peter Park
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | - Scott Koerber
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
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17
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Sliwa K, Viljoen CA. Reducing the Global Carbon Footprint of Cardiac Arrhythmia Management. JACC. ADVANCES 2023; 2:100351. [PMID: 38939581 PMCID: PMC11198638 DOI: 10.1016/j.jacadv.2023.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Karen Sliwa
- Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Charle Andre Viljoen
- Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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18
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Environmental sustainability in cardiology: reducing the carbon footprint of the catheterization laboratory. Nat Rev Cardiol 2023; 20:69-70. [PMID: 36543992 DOI: 10.1038/s41569-022-00826-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Zahhaf O, D'Ambrogio G, Giunta A, Le MQ, Rival G, Cottinet PJ, Capsal JF. Molten-State Dielectrophoretic Alignment of EVA/BaTiO 3 Thermoplastic Composites: Enhancement of Piezo-Smart Sensor for Medical Application. Int J Mol Sci 2022; 23:15745. [PMID: 36555385 PMCID: PMC9779483 DOI: 10.3390/ijms232415745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Dielectrophoresis has recently been used for developing high performance elastomer-based structured piezoelectric composites. However, no study has yet focused on the development of aligned thermoplastic-based piezocomposites. In this work, highly anisotropic thermoplastic composites, with high piezoelectric sensitivity, are created. Molten-state dielectrophoresis is introduced as an effective manufacturing pathway for the obtaining of an aligned filler structure within a thermoplastic matrix. For this study, Poly(Ethylene-co Vinyl Acetate) (EVA), revealed as a biocompatible polymeric matrix, was combined with barium titanate (BaTiO3) filler, well-known as a lead-free piezoelectric material. The phase inversion method was used to obtain an optimal dispersion of the BaTiO3 within the EVA thermoplastic matrix. The effect of the processing parameters, such as the poling electric field and the filler content, were analyzed via dielectric spectroscopy, piezoelectric characterization, and scanning electron microscopy (SEM). The thermal behavior of the matrix was investigated by thermogravimetric analysis (TGA) and differential scanning calorimetry analysis (DSC). Thermoplastic-based structured composites have numerous appealing advantages, such as recyclability, enhanced piezoelectric activity, encapsulation properties, low manufacturing time, and being light weight, which make the developed composites of great novelty, paving the way for new applications in the medical field, such as integrated sensors adaptable to 3D printing technology.
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Affiliation(s)
- Omar Zahhaf
- Laboratoire de Génie Electrique et Ferroélectricité, Campus Ladoua, Institut National des Sciences Appliquées, Université de Lyon, 69621 Villeurbanne, France
| | - Giulia D'Ambrogio
- Laboratoire de Génie Electrique et Ferroélectricité, Campus Ladoua, Institut National des Sciences Appliquées, Université de Lyon, 69621 Villeurbanne, France
| | - Angela Giunta
- Laboratoire de Génie Electrique et Ferroélectricité, Campus Ladoua, Institut National des Sciences Appliquées, Université de Lyon, 69621 Villeurbanne, France
- Department Materials Engineering and Nanotechnology, Politecnico di Milano, Campus Leonardo, 20133 Milan, Italy
| | - Minh-Quyen Le
- Laboratoire de Génie Electrique et Ferroélectricité, Campus Ladoua, Institut National des Sciences Appliquées, Université de Lyon, 69621 Villeurbanne, France
| | - Guilhem Rival
- Laboratoire de Génie Electrique et Ferroélectricité, Campus Ladoua, Institut National des Sciences Appliquées, Université de Lyon, 69621 Villeurbanne, France
| | - Pierre-Jean Cottinet
- Laboratoire de Génie Electrique et Ferroélectricité, Campus Ladoua, Institut National des Sciences Appliquées, Université de Lyon, 69621 Villeurbanne, France
| | - Jean-Fabien Capsal
- Laboratoire de Génie Electrique et Ferroélectricité, Campus Ladoua, Institut National des Sciences Appliquées, Université de Lyon, 69621 Villeurbanne, France
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