It is when you only have one health and you have to restart the room. It is literally "9 Chances to clear out a room without getting hit" Which when it comes to facing the heart, near impossible.
It's not actually too bad though if you're like Azazel. Chances are you won't even lose a life because 1 health isn't bad when you have 11 evil hearts. If you pick up dead cat when you have only one red heart, it's really good, because it's a Guppy item and has no negative consequences.
Unless you are Blue Baby, it doesn't affect Soul, Black, and Eternal Hearts. In fact, you gain a Red Heart when you pick up a dead cat in those circumstances (except, unless, you are playing as the Blue Baby).
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It's pretty good, nine lives isn't bad.