Goodwill and Intangible Assets

9 Months Ended

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