I think I've heard complaints from people using it more with .net workflows, I'm a C++ programmer myself and it's been as solid as anything.
If anything, plugins creating havoc on host processes have given a reason why extensibility should be done out of process with IPC, despite consuming more resources.
Not only on VS, on other IDEs as well.
Given that, it is no surprise that the new extensibility API is out-of-process.
I also did a fair bit of .net in my last job and I could not live without Resharper C#. If the company wouldn’t have paid for it then I would. Resharper C++ is not good though.