We've had zero problems with it in 7 (almost 8) years. The advantage is having 2 bathrooms and being able to design with one black tank and not necessarily placed below the bathroom.
There is noise, you can't flush silently, but our is under the kitchen so it doesn't affect sleep in the bedroom, and it's easy access if service is needed. There is enough room and clearance that it would be easy to place an insulated box over the pump and small holding tank associated with the system to further block the sound. I don't think the pump runs enough to worry about heat buildup.
We leave our vacuum switch on almost all the time.
The only issue is occasional debris that prevents the seal in the bottom of the commode to allow enough vacuum and the pump cycles. Usually happens when people who are not used to the toilet don't flush with enough water and a little TP catches in the seal. Dometic provided tools with the documentation that make cleaning the seal very easy.
Doug