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Goodwill and Intangible Assets | 6 Months Ended
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Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill and Intangible Assets | 6. Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the six-month period ended June 30, 2020 were as follows (in thousands): ​
​ | ​ | ​ | ​
​ |  | 2020
Goodwill balance at January 1 | ​ | $ | 353,193
Effect of foreign exchange | ​ |  | (215)
Additions and adjustments as the result of acquisitions | ​ |  | 115
Goodwill balance at June 30 | ​ | $ | 353,093
​ Total accumulated goodwill impairment losses aggregated to approximately $8.3 million as of June 30, 2020 and December 31, 2019. We did not have any goodwill impairments for the six-month periods ended June 30, 2020 and 2019. The total goodwill balance as of June 30, 2020 and December 31, 2019 was related to our cardiovascular segment. ​ Other intangible assets at June 30, 2020 and December 31, 2019 consisted of the following (in thousands): ​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | June 30, 2020
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 24,492 | ​ | $ | (7,863) | ​ | $ | 16,629
Distribution agreements | ​ |  | 5,754 | ​ |  | (4,723) | ​ |  | 1,031
License agreements | ​ |  | 21,957 | ​ |  | (8,698) | ​ |  | 13,259
Trademarks | ​ |  | 30,242 | ​ |  | (10,936) | ​ |  | 19,306
Customer lists | ​ |  | 34,698 | ​ |  | (27,706) | ​ |  | 6,992
In-process technology | ​ |  | 2,500 | ​ |  | — | ​ |  | 2,500
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
Total | ​ | $ | 119,643 | ​ | $ | (59,926) | ​ | $ | 59,717
​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | December 31, 2019
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents |  | $ | 22,703 | ​ | $ | (6,863) | ​ | $ | 15,840
Distribution agreements | ​ |  | 8,012 | ​ |  | (6,794) | ​ |  | 1,218
License agreements | ​ |  | 26,987 | ​ |  | (12,746) | ​ |  | 14,241
Trademarks | ​ |  | 30,240 | ​ |  | (9,477) | ​ |  | 20,763
Covenants not to compete | ​ |  | 964 | ​ |  | (964) | ​ |  | —
Customer lists | ​ |  | 39,984 | ​ |  | (28,763) | ​ |  | 11,221
In-process technology | ​ |  | 2,500 | ​ |  | — | ​ |  | 2,500
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
Total | ​ | $ | 131,390 | ​ | $ | (65,607) | ​ | $ | 65,783
​ Aggregate amortization expense the three and six-month periods ended June 30, 2020 was approximately $14.8 million and $29.8 million, respectively. Aggregate amortization expense for the three and six-month periods ended June 30, 2019 was approximately $14.9 million and $29.7 million, respectively. ​ We evaluate long-lived assets, including amortizing intangible assets, for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. We perform the impairment analysis at the asset group for which the lowest level of identifiable cash flows is largely independent of the cash flows of other assets and liabilities. We compare the carrying value of the amortizing intangible assets acquired to the undiscounted cash flows expected to result from the asset group and determine whether the carrying amount is recoverable. We determine the fair value of our amortizing assets based on estimated future cash flows discounted back to their present value using a discount rate that reflects the risk profiles of the underlying activities. During the three-month period ended June 30, 2020, we identified indicators of impairment associated with certain acquired intangible assets based on our qualitative assessment, which led us to complete an interim quantitative impairment assessment. The primary indicator of impairment was our planned closure of our procedural pack business in Australia acquired in our October 2017 acquisition of ITL Healthcare Pty Ltd. (“ITL”). We recorded an impairment charge for ITL intangible assets of approximately $2.4 million during the three months ended June 30, 2020, all of which pertained to our cardiovascular segment. During the three months ended June 30, 2019 we recorded an impairment charge of $548,000 for the discontinuation of our product associated with the assets acquired in our June 2017 acquisition of patent rights and other intellectual property related to the Repositionable Chest Tube and related devices from Lazarus Medical Technologies, LLC. ​ Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of June 30, 2020 (in thousands): ​
​ | ​ | ​ | ​
Year Ending December 31, |  | Estimated Amortization Expense
Remaining 2020 | ​ | $ | 29,180
2021 | ​ |  | 51,348
2022 | ​ |  | 50,225
2023 | ​ | ​ | 49,090
2024 | ​ |  | 46,276
​

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- Definition The entire disclosure for goodwill and intangible assets. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -URI http://asc.fasb.org/topic&trid=2144416 + Details
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