Hepatic dysfunction is a complication following mechanical circulatory support (MCS) device use. These devices are essential for patients with severe heart failure or cardiac arrest, serving as a bridge to recovery or transplantation. Still, they introduce risks, notably, hepatic dysfunction, which can severely impact patient outcomes. The pathophysiology is multifactorial, involving hemodynamic changes, hypoxia, ischemia-reperfusion injury, inflammation, and drug toxicity. Clinical presentations range from mild enzyme elevations to severe liver failure, complicating diagnosis due to overlapping signs and symptoms with heart failure. Management focuses on hemodynamic optimization, pharmacological therapy, nutritional support, and managing complications, with severe cases potentially requiring combined heart and liver transplantation. Key factors influencing outcomes include right ventricular dysfunction, baseline bilirubin levels, and cardiopulmonary bypass duration. The MELD score and antithrombin III levels are useful for risk stratification, anticipating perioperative blood product use, and predicting adverse outcomes. Future directions include early detection, goal-oriented optimization, and innovations in MCS device design to reduce hepatic dysfunction and improve patient care.