I've been using Vista Premium 64-bit for a couple of weeks now. I have had to scour for some updated drivers (HD back-up, Saitek X52, Forceware), but my experience has generally been very good. The OS itself actually does seem more stable than XP: much less crashing in IE, apps not responding etc. Also, some programs are noticeably snappier on 64-bit - ProTools and RDP come to mind. Of course, you have the added benefit of being able to use a full 4GB+ of RAM and have apps allocate over 2GB, which will become more and more important.
TWO MAJOR CAUTIONS:
1) Many people, if not all, with 8800's and Vista 64 have been getting intermittant driver failures where the screen flashes and returns. You will almost definitely experience this. More info here:
http://forums.nvidia.com/index.php?showtopic=25381&st=1480 . Nvidia and MS have been aware of this issue since Jan., but are unwilling/unable to fix it. There's actually a class-action suit in the works, lol. I was getting these errors, but disabled Aero (which is pretty much worthless fluff imo), and it stopped. Now my UI looks like Windows 3.1
2) If you use iTunes, it will not install out of the box in 64 (wtf?). You need to do some cmt redirection, which can be tricky if not familiar. iPhone software doesn't work at all.
Edit: In terms of gaming, I've had great experiences. Stalker, SupComm, World in Conflict Beta, and Fear all run perfectly with no noticable difference in performance or stability from XP. I'd agree with the poster above in that nV is finally getting there act together with drivers. Now we just have to wait for real DX10 games to see how well 8800 and Vista 64 performs...