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Cook the rigatoni in a large pot of boiling salted water according to the package instructions until al dente. Reserve 1 cup of pasta cooking water, then drain the pasta.
In a large skillet over medium-high heat, warm the olive oil. Add the sage leaves for 30 seconds.
Stir in the garlic and lemon zest, and sauté for about a minute.
Pour in the heavy cream and season with salt and freshly ground black pepper. Let the mixture simmer for about 4 minutes, allowing it to slightly thicken.
Add the al dente rigatoni to the skillet, followed by the grated Parmesan cheese. Toss the pasta in the creamy sauce, adding reserved pasta water in increments as needed to achieve a smooth, creamy consistency. Continue to cook for about 3 minutes, or until the pasta is well-coated and fully cooked.
Stir in the fresh parsley until well combined.
Serve the rigatoni and garnish with additional lemon zest, chopped parsley, and a sprinkle of grated Parmesan cheese.