Persistent left superior vena cava (PLSVC) encountered during heart transplant in either the donor or the recipient is highly unusual and significantly complicates the operation. Several options exist to manage this condition, including the use of a prosthetic graft that reconstructs the anatomy by linking the PLSVC to the right atrium, with different areas of placement of the conduit itself. The authors share a novel technique that avoids the use of prosthetic material, simplifies this operation, reduces cardiopulmonary bypass time, and is reproducible. The technique involves using a modified cardiectomy that unifies the recipient coronary sinus and inferior vena cava followed by anastomosis of this structure to the donor inferior vena cava en bloc.