The main issue is that in MAME's normal operation it waits for the start of a new video frame, runs all the emulation as quickly as possible, and then sleeps the rest of the frame time. (so-called "hurry to sleep" that became a big deal on phones). That works fine for games and computers and even Game and Watches, but it introduces lag when talking to the outside world.

Even that is OK for serial/parallel and Ethernet comms with emulated machines, but MIDI is a special case where there's enough lag between pressing a key and hearing it that even crappy players like myself get completely discombobulated.

You can record what you want separately as a MIDI sequence and then play it through the synth in MAME to get a .WAV you can paste into a DAW, but MAME as a real-time workflow isn't there yet. Our basic plan is to increase the "frame rate" for synths significantly (to something like 240 Hz) but there are of course complications with that that we need to work through.