They're an accessibility problem that keeps Patrick Klepek from being able to play games featuring them.
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Oh, don't go there. I tried to imagine the internal anatomy of a centaur, and I wound up with the human portion housing only a very long oesophagus (and maybe a small backup heart if the story wants it), with the heart and other important stuff being stored in the horse chassis.
Oh, and the brain is in the human portion. Which is why my centaurs are vicious brutes. Not because of the human per se, but because of the trope about the brain not leaving enough room for smarts after it needs to control horse-sized stuff. :P