Outcomes of long-term central venous access devices in pulmonary arterial hypertension: A 10-year case series

INTRODUCTION: Continuous prostacyclin infusion is the standard of care for pulmonary arterial hypertension, requiring central venous access devices where dwell time is critical but associated with complications. METHODS: Retrospective 10-year case series of 18 adult pulmonary arterial hypertension patients managed through central venous access devices by a specialized multidisciplinary team. RESULTS: Sixty-nine catheters were analyzed across 18 patients; median catheter survival estimated by the Kaplan-Meier method was 9.3 months (95% confidence interval (8.1-12)). Occlusion was the most frequent complication (1.20 per 1,000 catheter-days) and the leading removal reason across all device types. Catheter-related bloodstream infections occurred in four instances (0.22 per 1,000 catheter-days), with methicillin-susceptible Staphylococcus aureus as the only isolated pathogen. Catheter-related thrombosis was documented in two cases. Three catheters fractured, one of each device type. DISCUSSION: Evidence on central venous access device outcomes in pulmonary arterial hypertension remains scarce in middle-income countries. The median dwell time observed in this series was shorter than that reported in high-income country cohorts, while catheter-related bloodstream infection and thrombosis rates were numerically lower than those documented in comparable series. CONCLUSION: In this descriptive 10-year case series from a middle-income country, long-term central venous access devices for continuous epoprostenol infusion in pulmonary arterial hypertension were associated with a prolonged dwell time and low complication rates under a structured multidisciplinary follow-up model. Larger multicenter studies are needed to confirm generalizability and identify determinants of catheter longevity.