Background: Perioperative control of heart rate (HR) is important for achieving cardioprotection in high risk patients. However, effective HR control with B-blockers (BB) may be difficult to achieve and may be associated with increased risk, especially when initiated <1 week before surgery.Aim: To assess the effectiveness of ivabradine in reducing perioperative HR in patients undergoing vascular surgery.Method: Patients scheduled for elective open vascular surgery with HR > 75 bpm and revised cardiac risk index (RCRI) score > 1 were prospectively enrolled. Ivabradine was given to 45 patients (Ivab group) with any of the following: inadequate HR control despite BB therapy ; contraindication to BB ; or surgery schedules in less than a week. Another 26 patients received titrated doses of bisoprolol according to current guidelines (standard care group). Medications were continued for 30 days postoperatively. Cardiac troponin T (cTn) was measured on postoperative days 1, 3 and 7. Target HR was defined as < 65 bpm. Thirty-day cardiovascular events were the composite of cTn release, death and stroke. Results: Both groups were similar in terms of age, RCRI score, and surgical procedure. HR was similar in both groups before therapy ; but was significantly lower in Ivab group preoperatively (64±4 vs.71±9 beats/min, p < 0.001) and at first postoperative day (66±8 vs. 78±12 beats/min, p= 0.007) with similar rates of clinically significant hypotension or bradycardia. More patients in Ivab group than in standard care group achieved target HR (66% vs. 31%, p =0.003). Thirty-day cardiovascular events were higher in standard care group (37%) versus Ivab group (9%, p = 0.003); this was driven mainly by excess rate of cTn release. Independent predictors of cardiac events were: RCRI score (p =0.013); lack of aspirin use (p =0.01); and HR at first postoperative day (p =0.0007). Conclusion: In high risk patients undergoing vascular surgery, perioperative ivabradine is effective in HR control and may be associated with improved postoperative outcomes.