Back on top after mitral valve repair

Former U-M resident shares his story

Dr. Mel Twiest is back on top of the world, hiking 54 miles of England's Southwest Coast Path following surgery for mitral valve repair.

Dr. Mel Twiest hiked 54 miles of England’s Southwest Coast Path following surgery for mitral valve repair.

Dr. Mel Twiest, a general surgeon who attended the University of Michigan medical school and completed his residency at U-M in the early 1970s, found himself back in familiar surroundings recently, but this time in the role of patient. After experiencing shortness of breath while hiking in the mountains of Santa Fe a few years ago, the 70-year-old doctor realized something was wrong. He was diagnosed with severe mitral valve disease. After several procedures, including mitral valve repair, Dr. Twiest credits the U-M Frankel Cardiovascular Center team for getting him close to his goal of climbing a mountain again.

Dr. Twiest shares his experience …

I had my first encounter as a patient at U-M in February 2013 for an ablation procedure performed by Dr. Hakan Oral. He and the entire CVC team came highly recommended, so I didn’t hesitate to travel from Tennessee to Michigan for the procedure, which was successful. But Dr. Oral warned me at the time that I was going to get into further trouble with my mitral heart valve. Unfortunately, he was right. Continue reading

Mitral valve repair vs replacement

“Repair is always better”

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U-M patient Perry Katsiskas believes she made the right decision in choosing to have her mitral valve repaired versus a future replacement.

Panorea (Perry) Katsiskas’ mitral valve disease didn’t slow her down. A daily exerciser, she lived an active life, relatively free of symptoms. But Perry, like many of the millions of Americans diagnosed with a degenerative version of the disease, was faced with a decision: mitral valve repair vs replacement. In other words, should she have her mitral valve repaired now or wait until her condition required complete valve replacement?

Under the care and counsel of Dr. Francis D. Pagani, surgical director of the U-M Adult Heart Transplant Program and director of the Center for Circulatory Support, Perry chose to have her valve repaired. “Dr. Pagani explained that if and when I experienced symptoms, it would likely be too late,” she says.

“I came in feeling healthy, had surgery and went home feeling healthier,” says Perry. “I felt Dr. Pagani cared about me and my outcome. And the outcome speaks for itself. Early intervention saved the quality of my life.” Continue reading

What you should know about varicose vein treatment

Answers to questions about treatment cost, compression stockings and more

If you have tired or achy legs, you may have issues with vein health, including varicose veins.veins.fw (1) Patients often come to the U-M Vein Center with the same objective: They want their legs to look and feel great. Here are some of the questions I’m often asked about spider and varicose vein treatment.

“How much does varicose vein treatment cost?  Will my insurance cover it?”

We’re all conscious of our budgets, but I have learned some of this concern about cost arises from patients being told by well-meaning family, friends and even physicians that their condition is “cosmetic.” Most insurance companies cover diagnostic studies and treatment of symptomatic varicose veins (those that cause pain, aching, swelling, itching, calf/foot cramping). If you’re unsure whether your condition meets the criteria for coverage, our staff is happy to review coverage options for you. Continue reading

Important anticoagulant precautions

Vitamin K and aspirin can have a critical impact on blood-thinning meds

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Blood-thinning medications can be impacted by vitamin K and aspirin-containing products.

The formation of a clot in the body is a complex process that involves multiple substances called “clotting factors.” Clotting factors are proteins made in the liver. Some of these proteins, however, cannot be created without vitamin K, a common vitamin found in:

  • cabbage
  • cauliflower
  • spinach
  • other leafy green vegetables

Because anticoagulants such as warfarin (also known as Coumadin® or Jantoven®) slow clot formation by competing with vitamin K, it’s important to maintain a consistent daily intake of vitamin K and to be aware of anticoagulant precautions. Each person’s warfarin dosage is related to the amount of vitamin K in his or her body. If you overload your system with vitamin K, you override the effectiveness of the blood-thinning medication. Continue reading

What stress tests can and can’t predict

Answering two most frequently asked questions about stress tests

If you have chest pain or other symptoms of heart disease, you may be asked to complete a stress test stresstest.fwso your doctor can help determine the right treatment plan. Patients are often curious about how to interpret the results of a stress test or what the results may indicate. Let’s break down the two stress test related questions I most often receive: Continue reading

An aspirin a day … is it right for you?

Clearing the air on who benefits from a daily aspirin

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If you’ve had a heart attack, you should be taking a low-dose aspirin a day.

Aspirin is truly a wonder drug when it comes to coronary artery disease (CAD). But what about the Food and Drug Administration’s recently released statement saying an aspirin a day is only for a select few?

In medicine, we define our treatments for CAD as primary and secondary prevention measures.

Primary prevention

Patients who have never had a heart attack or do not have any formal diagnosis of CAD fall into what we refer to as the primary prevention group. In this group, we commonly further subdivide patients into low and high risk for developing CAD. The more risk factors a patient has (family history, diabetes, hypertension, high cholesterol), the higher his or her lifetime risk is for having a heart attack. Patients older than 50 who are at high risk for developing CAD might benefit from taking 81 mg of aspirin every morning.

Secondary prevention

Patients who have already had a heart attack or have been diagnosed with CAD fall into the secondary prevention category. In this group, our goal is to prevent a second cardiac event. Ideally, everyone in this group should be taking an aspirin a day. The current recommended dose is one or two baby aspirin (81 or 162 mg every morning). A higher aspirin dose (325 mg) doesn’t necessarily reduce the risk of another heart attack, but instead potentially increases a patient’s bleeding risk.

No “one size fits all”

It is difficult to come up with a blanket statement for all patients with respect to aspirin, as it also depends on a patient’s bleeding risk as well as other factors. If a patient has had a heart attack (and there are no contraindications for using aspirin), I encourage him or her to take 81 mg of aspirin every morning.

For the primary prevention group of patients (if there is no increased risk associated with taking aspirin, the patient has multiple cardiac risk factors and is age 50 or older), I prescribe 81 mg of aspirin every morning.

For all patients, I encourage you to discuss aspirin use with your doctor before starting. Finally, aspirin should be taken after breakfast to decrease stomach irritation.

Take the next step:

  • To make an appointment to discuss your need for treatment, contact us toll-free at 888-287-1082 or email us at 


tobin_kenneth 150x150Dr. Kenneth Tobin is a clinical assistant professor for the Department of Internal Medicine and director in the Chest Pain Center at the University of Michigan. His specialty is cardiology, with clinical interests in the association of patent foramen ovale and stroke, patent foramen ovale and migraine, preventive cardiology and echocardiography.



Frankel-informal-vertical-sigThe University of Michigan Samuel and Jean Frankel Cardiovascular Center is the top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at