Long-term efficacy of the treat-to-close strategy for patients with atrial septal defect-pulmonary artery hypertension and characteristics of indicated populations

• Treat-to-close benefits atrial septal defect with pulmonary hypertension. • Invasive hemodynamic tests identify patients who benefit from treat-to-close. • Most drug-sensitive patients close within one year of targeted drug therapy. • Early fall in pulmonary artery pressure with drug therapy shows a response. “Treat-to-close” strategy in the treatment of patients with Atrial Septal Defects (ASD) combined with severe Pulmonary Hypertension (PAH). This study explored the long-term survival of patients undergoing the “treat-to-close” strategy and the characteristics of the applicable population. A total of 141 ASD-PAH patients were collected. Patients were classified as “Occlusion Group” (OG) and “Conservative Treatment Group” (CTG) depending on the suitability of ASD occlusion after drug treatment. The baseline characteristics and long-term follow-up outcomes of the two groups were recorded. Patients in the OG underwent 5 (3.8) months of Pulmonary Artery-targeted Drug Therapy (PADT) before ASD occlusion. OG patients had better long-term survival ( p = 0.043). Pulmonary Vascular Resistance (PVR): Area Under the Curve (AUC) 0.813 (0.726‒0.899, p < 0.001), Pulmonary Arterial Oxygen Saturation (PASO2): AUC = 0.794 (95% CI: 0.682‒0.904 p < 0.001), Pulmonary Artery Systolic Pressure (PASP): AUC = 0.808 (95% Confidence Interval [95% CI]: 0.733‒0.883 p < 0.001) and PASO2 combined with PASP: 0.918 (95% CI: 0.854‒0.979 p < 0.001) contribute to the screening of drug-sensitive populations. The treat-to-close strategy significantly improves long-term patient survival. Initial intraoperative indications can help screen the beneficiary population. Larger-scale prospective studies are needed to validate the present findings.