Abstract: AIM: To compare the postoperative mental status in patients treated with cardiopulmonary bypass surgery by total thoracoscopy or by median sternotomy. METHODS: Differences in intake of painkillers,verbal rating scale( VRS),Hamilton Depression Scale( HAMD) and Hamilton Anxiety Scale( HAMA) were compared in patients with atrial septal defect who underwent atrial septal defect with total thoracoscopic surgery( TTS) or median sternotomy( MS). RESULTS: Intake rate of painkillers in the TTS group was remarkably lower than that in the MS group( 22 vs. 59%,P < 0. 05). Grading of VRS 12 h and 2 d after surgery as well as the grades of HAMD and HAMA in the TTS group were markedly lower than those in the MS group( P < 0. 05). CONCLUSION: Atrial septal defect repair under total thoracoscopy produces less pain and results in less depression and anxiety.