Mechanical circulatory assist systems and related methods produce a pulsatile blood flow in synchronization with heart activity. A mechanical circulatory assist system includes a continuous-flow pump and a controller. The continuous-flow pump is implantable in fluid communication with a left ventricle of a heart of a patient and an aorta of the patient to assist blood flow from the left ventricle to the aorta. The controller includes a sensor that generates a signal indicative of an activity of the heart. The controller is operatively connected to the continuous-flow pump and configured to operate the continuous-flow pump in an artificial pulse mode in synchronization with the activity of the heart.