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Goodwill and Intangible Assets | 9 Months Ended
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Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill and Intangible Assets | 6. Goodwill and Intangible Assets. The change in the carrying amount of goodwill for the nine-month period ended September 30, 2023 is detailed as follows (in thousands): ​
​ | ​ | ​ | ​
​ |  | 2023
Goodwill balance at January 1 | ​ | $ | 359,821
Effect of foreign exchange | ​ |  | (305)
Additions and adjustments as the result of acquisitions | ​ |  | 21,536
Goodwill balance at September 30 | ​ | $ | 381,052
​ Total accumulated goodwill impairment losses aggregated $8.3 million as of September 30, 2023 and December 31, 2022, respectively. We did not have any goodwill impairments for the nine-month periods ended September 30, 2023 or 2022. The total goodwill balances as of September 30, 2023 and December 31, 2022 were related to our cardiovascular segment. ​ Other intangible assets at September 30, 2023 and December 31, 2022 consisted of the following (in thousands): ​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | September 30, 2023
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 30,969 | ​ | $ | (12,657) | ​ | $ | 18,312
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,868) | ​ |  | 382
License agreements | ​ |  | 11,128 | ​ |  | (8,076) | ​ |  | 3,052
Trademarks | ​ |  | 35,119 | ​ |  | (19,998) | ​ |  | 15,121
Customer lists | ​ |  | 40,287 | ​ |  | (33,310) | ​ |  | 6,977
Total | ​ | $ | 120,753 | ​ | $ | (76,909) | ​ | $ | 43,844
​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | December 31, 2022
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 29,445 | ​ | $ | (10,203) | ​ | $ | 19,242
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,715) | ​ |  | 535
License agreements | ​ |  | 11,109 | ​ |  | (7,250) | ​ |  | 3,859
Trademarks | ​ |  | 30,221 | ​ |  | (17,863) | ​ |  | 12,358
Customer lists | ​ |  | 34,105 | ​ |  | (31,749) | ​ |  | 2,356
Total | ​ | $ | 108,130 | ​ | $ | (69,780) | ​ | $ | 38,350
​ Aggregate amortization expense for the three and nine-month periods ended September 30, 2023 was $15.4 million and $41.1 million, respectively. Aggregate amortization expense for the three and nine-month periods ended September 30, 2022 was $12.1 million and $36.3 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 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. We did not identify indicators of impairment in any intangible assets based on our qualitative assessment for the nine-month period ended September 30, 2023. ​ For the nine-month period ended September 30, 2022, 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 divestiture of the STD Pharmaceutical Products Limited (“STD Pharmaceutical”) business acquired in our August 2019 acquisition of Fibrovein Holdings Limited. On April 30, 2022, we completed the divestiture of Fibrovein Holdings Limited, in exchange for the termination of our obligations arising from the acquisition and the purchaser’s agreement to make potential future payments upon a qualifying disposition of the STD Pharmaceutical business. We recorded an impairment charge for the carrying value of $1.7 million of intangible assets during the nine months ended September 30, 2022, all of which pertained to our cardiovascular segment. ​ Estimated amortization expense for developed technology and other intangible assets for the next five years consisted of the following as of September 30, 2023 (in thousands):
​ | ​ | ​ | ​
​ |  | Estimated Amortization Expense
Remaining 2023 | ​ | $ | 15,764
2024 | ​ |  | 59,656
2025 | ​ |  | 57,661
2026 | ​ | ​ | 46,955
2027 | ​ |  | 43,774
​

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