Alloy 800H is commonly used in high temperatures and corrosive environments due to its exceptional strength and resistance to high temperatures, but the ingots are prone to longitudinal cracking during the hot working process because of its coarse solidification structure. Based on the heterogeneous nucleation effect of rare earth inclusions, a strategy is proposed to refine the solidification structure of alloy 800H by La treatment to solve the crack problem. In this study, four kinds of alloy 800H ingots (0, 120, 260 and 470 ppm La) were prepared to investigate the effect of La on the solidification structure. After adding La, the types of inclusion were changed, and the modification path of inclusions was Al2O3 (0 ppm La) → LaAlO3 (120 ppm La) → LaAlO3·La2O2S and La2O2S (260 ppm La) → La2O2S and La2O3 (470 ppm La). After adding La, the inclusion morphology tended to be more spherical and the average size smaller. The lattice misfit calculation indicated that La-containing inclusions can serve as heterogeneous nucleation cores, and the number of effective heterogeneous nucleation also increased with La content increased. The columnar to equiaxed transition occurred early with La treatment, the ratio of the equiaxed zone increased from 2.1% to 36.5%, and the average equiaxed grain size decreased from 2.56 to 0.43 μm with La content increased from 0 to 470 ppm. The solidification structure of alloy 800H was significantly refined by adding La, and can thus provide a new strategy to solve the crack problem.