IMO, we don't need any more gargantuan frameworks like WPF or WCF - which I do like but I think within them there's "a much smaller and cleaner" programming model "struggling to get out". We do need more features like LINQ, dynamic support, or async that help simplify, unify, bring order to the other stuff that's already there.
About the UI - the new extensions system kinda brings the limitations of the current UI model to the fore. A lot of the extensions I like (by themselves) add things to the context menu that are individually useful, but taken together they bloat the context menu to the point where it's unusable. I think there's a question of whether the UI structure scales well enough to handle all the capabilities the program now has, and maybe they should consider a rethink similar to what the Office team did that resulted in the Ribbon (which is not to say that they should copy the ribbon itself!) Although the VS2010 Productivity Power Tools are a good start for a UI rethink (if only they wouldn't crash the IDE all the time ...)