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I read in the wiki that you can turn a follower into a heart demon thing and give it to Ratoo for a permanent extra half heart. You lose the follower forever though, as in, no can bring back
For the demon Hathor, if you bring it in a crusade and go to the Heart room, Ratoo will claim that Hathor is his heart, and ask you to return it to him. If you choose to give him Hathor, you will lose the demon, and permanently lose the Follower that turned into Hathor. In exchange, you will permanently gain half a heart.
Easy: Begin with 4 hearts without upgrades, max with 5 hearts with upgrades
Normal: Begin with 3 hearts without upgrades, max with 4 hearts with upgrades
Hard: Begin with 2 hearts without upgrades, max with 3 hearts with upgrades
Very Hard: Begin with 1 heart without upgrades, max with 2 hearts with upgrades