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<article article-type="article-commentary" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" dtd-version="1.3" xml:lang="EN">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cardiovasc. Med.</journal-id><journal-title-group>
<journal-title>Frontiers in Cardiovascular Medicine</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cardiovasc. Med.</abbrev-journal-title></journal-title-group>
<issn pub-type="epub">2297-055X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcvm.2025.1660716</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>General Commentary</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Commentary: Transcatheter aortic valve replacement in a quadricuspid aortic valve: a systematic review and meta-analysis</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes"><name><surname>Ruzayqat</surname><given-names>Rajeh S. H.</given-names></name>
<xref ref-type="corresp" rid="cor1">&#x002A;</xref><uri xlink:href="https://loop.frontiersin.org/people/3124749/overview"/><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; original draft" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing &#x2013; original draft</role><role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &#x0026; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &#x0026; editing</role></contrib>
</contrib-group>
<aff id="aff1"><institution>Faculty of Medicine, Hebron University</institution>, <city>Hebron</city>, <country country="">Palestine</country></aff>
<author-notes>
<corresp id="cor1"><label>&#x002A;</label><bold>Correspondence:</bold> Rajeh S. H. Ruzayqat <email xlink:href="mailto:rajehruzayqat107@gmail.com">rajehruzayqat107@gmail.com</email></corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-01-27"><day>27</day><month>01</month><year>2026</year></pub-date>
<pub-date publication-format="electronic" date-type="collection"><year>2025</year></pub-date>
<volume>12</volume><elocation-id>1660716</elocation-id>
<history>
<date date-type="received"><day>06</day><month>07</month><year>2025</year></date>
<date date-type="rev-recd"><day>22</day><month>12</month><year>2025</year></date>
<date date-type="accepted"><day>29</day><month>12</month><year>2025</year></date>
</history>
<permissions>
<copyright-statement>&#x00A9; 2026 Ruzayqat.</copyright-statement>
<copyright-year>2026</copyright-year><copyright-holder>Ruzayqat</copyright-holder><license><ali:license_ref start_date="2026-01-27">https://creativecommons.org/licenses/by/4.0/</ali:license_ref><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p></license>
</permissions>
<kwd-group>
<kwd>aortic stenosis</kwd>
<kwd>QAV</kwd>
<kwd>quadricuspid aortic valves</kwd>
<kwd>systematic review</kwd>
<kwd>transcatheter aortic valve replacement</kwd>
</kwd-group><funding-group><funding-statement>The author(s) declared that financial support was not received for this work and/or its publication.</funding-statement></funding-group><counts>
<fig-count count="0"/>
<table-count count="0"/><equation-count count="0"/><ref-count count="1"/><page-count count="2"/><word-count count="0"/></counts><custom-meta-group><custom-meta><meta-name>section-at-acceptance</meta-name><meta-value>Heart Valve Disease</meta-value></custom-meta></custom-meta-group>
</article-meta>
</front>
<body>
<related-article id="RA1" related-article-type="commentary-article" ext-link-type="doi" xlink:href="10.3389/fcvm.2025.1572251" journal-id="Front. Cardiovasc. Med." journal-id-type="nlm-ta">A Commentary on <article-title>Transcatheter aortic valve replacement in a quadricuspid aortic valve: a systematic review and meta-analysis</article-title> By Khalifa MA, Hashim HT, Shimal AA, Riyas Mohamed FR, Ragunathan S, Al Sakini AS, Elbadawi MH, Irfan MR, Moqbel I, Almualed MM, Al-Ghuraibawi M and Al-Aboudi BS (2025). Front. Cardiovasc. Med. 12: 1572251. doi: <object-id>10.3389/fcvm.2025.1572251</object-id>.</related-article>
<p>Khalifa et al. (2025) conducted a systematic review evaluating the use of transcatheter aortic valve replacement (TAVR) in patients with a quadricuspid aortic valve (QAV). The study identified 11 case reports/series (<italic>n</italic>&#x2009;&#x003D;&#x2009;17) and summarized procedural characteristics and short-term outcomes (<xref ref-type="bibr" rid="B1">1</xref>).</p>
<p>The study title and the methods section state that a random-effects meta-analysis was performed, &#x201C;A random-effects model was used for meta-analysis,&#x201D; to assess procedural success and 30-day mortality. However, a detailed examination of the reported statistical methods and results does not identify a quantitative synthesis consistent with a meta-analysis. The analyses are conducted at the individual-patient level using a one-stage descriptive approach, as mentioned in the methods section, &#x201C;Individual participants&#x2019; data analysis was used. The analysis approach was a one-stage approach,&#x201D; without study-level effect estimates, variance calculations, measures of heterogeneity (e.g., <italic>I</italic><sup>2</sup>), or graphical meta-analytic outputs such as forest or funnel plots.</p>
<p>Although the authors state that a random-effects model was used, the described analytical approach does not reflect a random-effects meta-analysis as conventionally defined. In the absence of pooled estimates derived from multiple studies, the methodology more closely aligns with a descriptive systematic review of case reports rather than a meta-analysis.</p>
<p>Referring to the study as a &#x201C;meta-analysis&#x201D; may therefore overstate the level of quantitative evidence provided and could mislead readers regarding the strength and generalizability of the findings. Clarification of the analytical framework or a reconsideration of the terminology used in the title and methods would improve methodological transparency.</p>
</body>
<back>
<sec id="s1" sec-type="author-contributions"><title>Author contributions</title>
<p>RR: Writing &#x2013; original draft, Writing &#x2013; review &#x0026; editing.</p>
</sec>
<sec id="s3" sec-type="COI-statement"><title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s4" sec-type="ai-statement"><title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence, and reasonable efforts have been made to ensure accuracy, including review by the authors, wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec id="s5" sec-type="disclaimer"><title>Publisher&#x0027;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list><title>Reference</title>
<ref id="B1"><label>1.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Khalifa</surname> <given-names>MA</given-names></name> <name><surname>Hashim</surname> <given-names>HT</given-names></name> <name><surname>Shimal</surname> <given-names>AA</given-names></name> <name><surname>Riyas Mohamed</surname> <given-names>FR</given-names></name> <name><surname>Ragunathan</surname> <given-names>S</given-names></name> <name><surname>Al Sakini</surname> <given-names>AS</given-names></name><etal/></person-group> <article-title>Transcatheter aortic valve replacement in quadricuspid aortic valve: a systematic review and meta-analysis</article-title>. <source>Front Cardiovasc Med</source>. (<year>2025</year>) <volume>12</volume>:<fpage>1572251</fpage>. <pub-id pub-id-type="doi">10.3389/fcvm.2025.1572251</pub-id><pub-id pub-id-type="pmid">40535149</pub-id></mixed-citation></ref></ref-list>
<fn-group>
<fn id="n1" fn-type="custom" custom-type="edited-by"><p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1123360/overview">Ernesto Greco</ext-link>, Sapienza University of Rome, Italy</p></fn>
<fn id="n2" fn-type="custom" custom-type="reviewed-by"><p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3174295/overview">Bahar Darouei</ext-link>, Isfahan University of Medical Sciences, Iran</p></fn>
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