Our objective was to investigate the relationship between the long-term survival of surgical treatment and preoperative pulmonary vascular resistance (PVR) and pulmonary to systemic flow ratio (Qp/Qs) in congenital systemic-to-pulmonary shunt with andadvanced pulmonary hypertension. 1212 cases of congenital systemic-to-pulmonary shunt and advanced pulmonary hypertension were treated non-surgically or surgically and were entered into non-surgical group (n=297) and surgical group (n=915).Propensity score of inclusion into surgical group were estimated and 245 pairs were get with the propensity score matching between the two groups. Results: In the 245 propensity score matched pairs, the actuarial survival at 10 and 15 yrs of the surgical group was significantly higher than that of the non-surgical group when PVR was less than 15 WU or Qp/Qs was greater than 1.25(Log rank test, P = 0.0001 and 0.001 respectively), but the actuarial survival at 10 and 15 yrs of the two groups reached no significantly difference when PVR was greater than 15 WU or Qp/Qs was less than 1.25 (Log rank test, P = 0.596 and 0.424 respectively). The surgical closure therapy provides longer survival and much better life quality for the congenital systemic-to-pulmonary shunt and advanced pulmonary hypertension when it's PVR is less than 15 WU and/or its Qp/Qs is greater than 1.25. Surgical criteria for congenital systemic-to-pulmonary shunt and advanced pulmonary hypertension should be revised as preoperative PVR less than 15 and Qp/Qs greater than 1.25. © 2012 by Nova Science Publishers, Inc. All rights reserved.