I have some very old code that does just that. Here:
https://github.com/billthefarmer/c-accordion/blob/master/mac/Accordion.c#L1043.
It uses an AUGraph and send the midi events with MusicDeviceMIDIEvent()
once all the bits have been put together. Parts of this API have since
been deprecated and updated, but the updated functions are relatively
easy to find.
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