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In CF\u2010VAD patients, degradation of vWF into low MW multimers that are inefficient in facilitating coagulation occurs and has been primarily attributed to the supraphysiological shear stress associated with the CF\u2010VAD impeller.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this review, we evaluate information from the literature regarding the unraveling behavior of surface\u2010immobilized vWF under pulsatile and continuous flow pertaining to: (A) the process of arterial endothelial vWF production and release into circulation, (B) the critical shear stress required to unravel surface bound versus soluble vWF which leads to degradation, and (C) the role of pulsatility in on the production and degradation of vWF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Conclusion<\/jats:title><jats:p>Taken together, these data suggests that the loss of pulsatility and its impact on arterial endothelial cells plays an important role in the production, release, unraveling, and proteolytic degradation of vWF into low MW multimers, contributing to the development of AVWS. Restoration of pulsatility can potentially mitigate this issue by preventing AVWS and minimizing the risk of non\u2010surgical bleeding.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14456","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T07:20:38Z","timestamp":1669015238000},"page":"640-648","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Loss of pulsatility with <scp>continuous\u2010flow<\/scp> left ventricular assist devices and the significance of the arterial endothelium in <scp>von\u2010Willebrand<\/scp> factor production and degradation"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-9354","authenticated-orcid":false,"given":"Guruprasad A.","family":"Giridharan","sequence":"first","affiliation":[{"name":"Department of Bioengineering, J. B. 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