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Several reports consistently suggest that a pulsatile\u2010flow LVAD has more profound effects compared to continuous\u2010flow LVAD, though the responsible mechanisms are not fully understood. We hypothesized that arterial pulsatility, being affected by the type of LVAD, may affect microvasculature and functional\/pathological LV remodeling in end\u2010stage cardiomyopathy. The study included 18 patients with chronic heart failure who underwent LVAD implantation. Eight patients were implanted with pulsatile\u2010flow LVAD, and 10 patients were implanted with continuous\u2010flow LVAD. The results of serial echocardiograms and histopathological assessment of transmural LV tissues, which were collected during the implantation and removal of LVADs, were compared between the groups. The results of echocardiography showed that LV systolic dimension and LV ejection fraction improved greatly in the pulsatile\u2010flow LVAD group compared to the continuous\u2010flow LVAD group. Histological analysis showed that in both groups, increased microvasculature density and decreased cardiomyocyte size during LVAD support had no significant difference. In contrast, only the patients with continuous\u2010flow LVADs had presented with significant increase in \u03b1\u2010smooth muscle actin (\u03b1\u2010SMA)\u2010positive layer thickness and the number of proliferating cell nuclear antigen (PCNA)\u2010positive cells of myocardial arterioles. We concluded that the use of long\u2010term continuous\u2010flow LVAD support, having less pulsatility, had induced more thickening to the medial layer of myocardial arterioles compared to the use of pulsatile\u2010flow LVADs. Our findings suggest that the pathological impairment of myocardial microvascular structure during continuous\u2010flow LVAD support may be a novel mechanism which accounts for the difference in LV remodeling depending on the type of LVAD.<\/jats:p>","DOI":"10.1111\/aor.13348","type":"journal-article","created":{"date-parts":[[2018,8,22]],"date-time":"2018-08-22T15:51:13Z","timestamp":1534953073000},"page":"350-362","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effect of Continuous\u2010Flow Mechanical Circulatory Support on Microvasculature Remodeling in the Failing Heart"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5776-1877","authenticated-orcid":false,"given":"Tetsuya","family":"Saito","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Suita Osaka 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