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Goodwill and Intangible Assets | 9 Months Ended
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Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill and Intangible Assets | 6. Goodwill and Intangible Assets. The change in the carrying amount of goodwill by segment for the nine-month period ended September 30, 2024 is detailed as follows (in thousands): ​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ |  | Cardiovascular | ​ | Endoscopy | ​ | Total
Goodwill balance at January 1 | ​ | $ | 382,240 | ​ | $ | — | ​ | $ | 382,240
Effect of foreign exchange | ​ |  | 211 | ​ |  | — | ​ |  | 211
Additions and adjustments as the result of acquisitions | ​ |  | — | ​ |  | 16,997 | ​ |  | 16,997
Goodwill balance at September 30 | ​ | $ | 382,451 | ​ | $ | 16,997 | ​ | $ | 399,448
​ Total accumulated goodwill impairment losses aggregated to $8.3 million as of September 30, 2024 and December 31, 2023, respectively. We did not have any goodwill impairments for the nine-month periods ended September 30, 2024 or 2023. ​ Other intangible assets at September 30, 2024 and December 31, 2023 consisted of the following (in thousands): ​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | September 30, 2024
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 30,472 | ​ | $ | (12,315) | ​ | $ | 18,157
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,975) | ​ |  | 275
License agreements | ​ |  | 11,599 | ​ |  | (8,979) | ​ |  | 2,620
Trademarks | ​ |  | 40,538 | ​ |  | (23,235) | ​ |  | 17,303
Customer lists | ​ |  | 46,959 | ​ |  | (35,475) | ​ |  | 11,484
Total | ​ | $ | 132,818 | ​ | $ | (82,979) | ​ | $ | 49,839
​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | December 31, 2023
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 28,877 | ​ | $ | (10,916) | ​ | $ | 17,961
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,919) | ​ |  | 331
License agreements | ​ |  | 11,142 | ​ |  | (8,327) | ​ |  | 2,815
Trademarks | ​ |  | 35,135 | ​ |  | (20,804) | ​ |  | 14,331
Customer lists | ​ |  | 40,367 | ​ |  | (33,921) | ​ |  | 6,446
Total | ​ | $ | 118,771 | ​ | $ | (76,887) | ​ | $ | 41,884
​ Aggregate amortization expense for the three and nine-month periods ended September 30, 2024 was $16.9 million and $46.4 million, respectively. Aggregate amortization expense for the three and nine-month periods ended September 30, 2023 was $15.4 million and $41.1 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. If a triggering event is identified, 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 for our intangible assets based on our consideration of triggering events for the nine-month periods ended September 30, 2024 and 2023, respectively. ​ Estimated amortization expense for developed technology and other intangible assets for the next five years consisted of the following as of September 30, 2024 (in thousands):
​ | ​ | ​ | ​
​ |  | Estimated Amortization Expense
Remaining 2024 | ​ | $ | 17,783
2025 | ​ |  | 69,119
2026 | ​ |  | 58,484
2027 | ​ | ​ | 54,947
2028 | ​ |  | 53,409
​

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- Definition The entire disclosure for goodwill and intangible assets. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Topic 350 -SubTopic 30 -Name Accounting Standards Codification -Publisher FASB -URI https://asc.fasb.org/350-30/tableOfContent Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef -Topic 350 -SubTopic 20 -Name Accounting Standards Codification -Publisher FASB -URI https://asc.fasb.org/350-20/tableOfContent + Details
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